An Institutional Evaluation of Medical Student Interest in Care for the Underserved

Background and Objectives: The United States of America is currently experiencing a shortage of physicians caring for underserved populations, perpetuated in part by increasingly negative attitudes during medical school towards working with these populations. The objective of this study is to provide a baseline assessment of the attitudes of all medical students at our institution towards caring for the underserved that will then guide the development, implementation and evaluation of a multi-pronged, 5-year intervention. Methods: For this mixed methods, cross-sectional study, we administered the validated Medical Student Attitudes Towards the Underserved (MSATU) survey to all 4 classes at one medical school within one academic year. Statistical analysis was performed through bivariate analyses followed by multivariate regression analyses for significant bivariate associations. Three focus groups involving a total of 23 second-, third- and fourth-year medical students provided qualitative data. Results: The s urvey response rate was 72% (n= 280/395). Higher MSATU scores were significantly associated with an interest in a primary care career and with prior work with the medically underserved. We found no significant association between score and year of training. Focus group participants cited: (1) exposure to underserved populations and (2) clinician role models as major factors affecting their attitudes towards the underserved. Conclusions: In our cross-sectional analysis, student attitudes towards underserved populations did not decline over the span of 4 medical school classes. Ongoing research will attempt to understand more deeply the relationship between medical student characteristics and the decision to care for underserved patients after graduation.