患者社会经济地位对一年级和二年级医学生认知的影响。
Effect of patient socioeconomic status on perceptions of first- and second-year medical students.
作者信息
Woo James K H, Ghorayeb Sahar H, Lee Cheong K, Sangha Harpreet, Richter Suzanne
机构信息
University of Western Ontario, London, Ont.
出版信息
CMAJ. 2004 Jun 22;170(13):1915-9. doi: 10.1503/cmaj.1031474.
BACKGROUND
Physician decision-making and perceptions of patients are affected by a patient's socioeconomic status (SES). We sought to determine if the perceptions of first- and second-year medical students are similarly affected. We also wanted to determine whether a student's own SES affects his or her perceptions of patients from a low or high SES background.
METHODS
Two similar videos of a physician-patient interview were created. One video featured a patient of apparently high SES and the other featured a patient of apparently low SES. Differences in SES were portrayed by means of clothing, accessories and dialogue. First- and second-year medical students at the University of Western Ontario were recruited to view 1 of the videos and to answer a questionnaire using a 5-point Likert scale.
RESULTS
Responses were obtained from 205 (89%) of the 231 medical students invited to participate. Respondents' perceptions of the low SES and high SES patients were significantly different in the following respects. The low SES patient was perceived to be less compliant in taking medications and less likely to return for follow-up visits; was perceived to have a lower level of social support, poorer overall health and a worse prognosis; and was perceived to be more adversely affected in his occupational duties by illness (p < 0.05). Furthermore, second-year students who watched the video with the low SES patient were less inclined to want that patient in their practice than second-year students who watched the video with the high SES patient (p = 0.032). One hundred and six students (52%) were categorized as having high SES and 37 (18%) as having low SES (the remaining students were categorized as having mid-level SES). Among students who watched the video with the low SES patient, the level of agreement with the statement "This person is the kind of patient I would like to have in my practice" was greater among low SES students than among high SES students (p = 0.012).
INTERPRETATION
First- and second-year medical students have negative perceptions of low SES patients on several dimensions.
背景
医生的决策以及对患者的看法会受到患者社会经济地位（SES）的影响。我们试图确定一年级和二年级医学生的看法是否也受到类似影响。我们还想确定学生自身的社会经济地位是否会影响其对来自低社会经济地位或高社会经济地位背景患者的看法。
方法
制作了两段相似的医患访谈视频。一段视频中的患者社会经济地位明显较高，另一段视频中的患者社会经济地位明显较低。通过服装、配饰和对话来展现社会经济地位的差异。招募了西安大略大学的一年级和二年级医学生观看其中一段视频，并使用5点李克特量表回答一份问卷。
结果
受邀参与的231名医学生中有205名（89%）给出了回复。在以下方面，受访者对低社会经济地位患者和高社会经济地位患者的看法存在显著差异。低社会经济地位患者被认为服药依从性较差，复诊可能性较小；被认为社会支持水平较低、整体健康状况较差且预后较差；被认为疾病对其工作职责的负面影响更大（p<0.05）。此外，观看低社会经济地位患者视频的二年级学生比观看高社会经济地位患者视频的二年级学生更不愿意在自己的诊疗工作中接收该患者（p = 0.032）。106名学生（52%）被归类为高社会经济地位，37名（18%）被归类为低社会经济地位（其余学生被归类为中等社会经济地位）。在观看低社会经济地位患者视频的学生中，低社会经济地位学生比高社会经济地位学生对“这个人是我希望在自己诊疗工作中接收的患者类型”这一陈述的认同程度更高（p = 0.012）。
解读
一年级和二年级医学生在多个方面对低社会经济地位患者持有负面看法。
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