全国医学生从事服务欠缺人群医疗服务意向的纵向调查。

A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

机构信息

T.F. O'Connell is a second-year internal medicine resident, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois. S.A. Ham is senior statistician, Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois. T.G. Hart is a third-year general surgery resident, Pritzker School of Medicine, University of Chicago, Chicago, Illinois. F.A. Curlin is Josiah C. Trent Professor of Medical Humanities, Trent Center for Bioethics, Humanities & History of Medicine, School of Medicine, Duke University, Durham, North Carolina. J.D. Yoon is assistant professor of medicine, MacLean Center for Clinical Medical Ethics, Department of Medicine, University of Chicago, Chicago, Illinois.

出版信息

Acad Med. 2018 Jan;93(1):90-97. doi: 10.1097/ACM.0000000000001816.

DOI:10.1097/ACM.0000000000001816

PMID:28678105

Abstract

PURPOSE

To explore students' intentions to practice in medically underserved areas.

METHOD

In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics.

RESULTS

Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]).

CONCLUSIONS

Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

摘要

目的

探讨医学生在医疗资源匮乏地区执业的意愿。

方法

2011 年 1 月，邀请了 24 所美国医学院的 960 名三年级医学生参加了一项关于他们在医疗资源匮乏地区执业意愿的调查。2011 年 9 月向参与者发送了后续调查。协变量包括学生人口统计学、医学院特征、环境暴露、工作经验、使命感和宗教特征。

结果

调整后的回复率分别为 919 名（第一份调查问卷）中的 564 名（564/919，61.4%）和 564 名（第一份调查问卷）中的 474 名（474/564，84.0%）。在四年级医学生中，预计有 34.3%的人有意在服务不足的人群中执业。在多变量逻辑回归模型中，预测在服务不足人群中执业的意愿的因素包括在服务不足的环境中长大（比值比范围：2.96-4.81）、强烈的使命感（比值比范围：1.86-3.89）和高医学院社会使命评分（在第四年：OR=2.34[95%置信区间（CI），1.31-4.21]）。国际经验与第四年思维方式的有利变化有关（OR=2.86[95%CI，1.13-7.24]）。高内在宗教信仰与在服务不足的环境中从事初级保健的意愿有关（第四年：OR=2.29[95%CI=1.13-4.64]）。