Zinn W M, Sullivan A M, Zotov N, Peters A S, Connelly M T, Singer J D, Block S D
Department of Medicine, Cambridge Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Acad Med. 2001 Apr;76(4):355-65. doi: 10.1097/00001888-200104000-00014.
To examine changes among a nationally representative sample of students and residents in their orientations toward primary care as reflected in their attitudes toward the psychosocial and technical aspects of medicine and their perceptions of the academic environment for primary care.
Confidential telephone interviews of stratified national probability samples of first- and fourth-year medical students and residents were conducted in 1994 and 1997. The 1997 survey included 219 students and 241 residents who had also been interviewed in 1994. Participants were asked about their attitudes toward addressing psychosocial issues in medicine and their perceptions of faculty and peer attitudes toward primary care. Responses were compared over time and across groups.
Between the first and fourth years of medical school, there was a decline over time in students' reported orientations to socioemotional aspects of patient care (61.6% versus 42.7%, p =.001) and their perceptions that working with psychosocial issues of patients made primary care more attractive (56.3% versus 43.5%, p =.01). This pattern continued for 1997 residents (PGY-3), who were even less likely to say that addressing psychosocial issues made primary care more attractive (26.9%). For fourth-year students in 1994 who became PGY-3 residents in 1997, there was an increased perception that non-primary-care house officers and specialty faculty had positive attitudes toward primary care (20.8% versus 33.0%, p =.005; 28.3% versus 45.7%, p <.0001; respectively).
Between 1994 and 1997 students and residents perceived a positive shift in the attitudes of peers and faculty toward primary care. During the course of their education and training, however, the students experienced an erosion of their orientations to primary care as they progressed through medical school into residency.
调查全国具有代表性的医学生和住院医师样本在对初级保健的取向方面的变化，这些变化体现在他们对医学心理社会和技术方面的态度以及对初级保健学术环境的认知上。
1994年和1997年对一年级和四年级医学生及住院医师的分层全国概率样本进行了保密电话访谈。1997年的调查包括219名学生和241名住院医师，他们也曾在1994年接受过访谈。参与者被问及他们对处理医学中心理社会问题的态度以及他们对教员和同伴对初级保健态度的认知。对不同时间和不同群体的回答进行了比较。
在医学院学习的第一年到第四年期间，学生报告的对患者护理社会情感方面的取向随时间下降（61.6%对42.7%，p = 0.001），并且他们认为处理患者的心理社会问题使初级保健更具吸引力的认知也下降了（56.3%对43.5%，p = 0.01）。1997年的住院医师（PGY - 3）也呈现出这种模式，他们更不太可能表示处理心理社会问题使初级保健更具吸引力（26.9%）。对于1994年的四年级学生，他们在1997年成为PGY - 3住院医师，他们更加强烈地认为非初级保健住院医师和专科教员对初级保健持积极态度（分别为20.8%对33.0%，p = 0.005；28.3%对45.7%，p < 0.0001）。
1994年至1997年期间，学生和住院医师察觉到同伴和教员对初级保健的态度发生了积极转变。然而，在他们的教育和培训过程中，随着学生从医学院进入住院医师阶段，他们对初级保健的取向逐渐减弱。
