The effect of a required third-year family medicine clerkship on medical students' attitudes: value indoctrination and value clarification.

BACKGROUND

The effect of a required six-week third-year family medicine clerkship was examined within a framework of professional socialization. Socialization was considered to consist of an institutional process, i.e., value indoctrination, and a learner process, i.e., value clarification.

METHOD

Pre- and postclerkship data from 1,095 students (classes of 1981-1993) at the University of Arizona College of Medicine were analyzed. In addition, specialty match data were obtained. Factor analysis of 19 items on the pre- and postclerkship questionnaires was used to derive four scales measuring attitudes related to family medicine. The students were first grouped into four groups: those who preferred family medicine before and after the clerkship, those who preferred other specialties both times, those who switched to family medicine, and those who switched away from family medicine. Then the students were grouped into eight groups by dividing each of the specialty-preference groups into two sections: those who matched to family medicine and those who did not. Statistical comparisons involved the use of the t and F statistics.

RESULTS

Usable data were available for a maximum of 997 students (91%). The students' attitudes about family medicine changed during the clerkship to become more consistent with their postclerkship specialty preferences. In addition, more students preferred family medicine after the clerkship than before it. When each group was further divided into those matching and not matching into family medicine, no significant difference in attitudes was found between those matching and those not matching.

CONCLUSION

These results reflect both a value clarification process and a value indoctrination effect. The discrepancy between postclerkship specialty preferences and later match data indicates that the indoctrination effect and clarification process continue into the fourth year.