Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution
Special aspects of education
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AbstractBackground: Idealism declines in medical students over the course of training, with some studies identifying the beginning of the decline in year 3 of US curricula. Purposes: This study tested the hypothesis that a decline in medical student idealism is detectable in the first two years of medical school. Methods: We sought to identify differences in survey responses between first-year (MS1) and second-year (MS2) medical students at the beginning (T1) and end (T2) of academic year 2010 on three proxies for idealism, including items asking about: (a) motivations for pursuing a medical career; (b) specialty choice; and (c) attitudes toward primary care. Principle component analysis was used to extract linear composite variables (LCVs) from responses to each group of questions; linear regression was then used to test the effect of on each LCV, controlling for race, ethnicity, rural or urban origins, gender, and marital status. Results: MS2s placed more emphasis on status/income concerns (&#x03B2;=0.153, p&#60;0.001), and much less emphasis on idealism as a motivator (&#x03B2;=&#x2212;0.081, p=0.054), in pursuing a medical career; more likely to consider lifestyle and family considerations (&#x03B2;=0.098, p=0.023), and less likely to consider idealistic motivations (&#x03B2;=&#x2212;0.066, p=NS); and were more likely to endorse both negative/antagonistic (&#x03B2;=0.122, p=0.004) and negative/sympathetic (&#x03B2;=0.126, p=0.004) attitudes toward primary care. Conclusions: The results are suggestive that idealism decline begins earlier than noted in other studies, implying a need for curricular interventions in the first two years of medical school.