Do clerkship experiences affect medical students' attitudes toward chronically ill patients?

Purpose. To measure changes in medical students' attitudes toward chronical ly ill patients, and to identify experiences, specifically during clerkship s, that contributed to students' attitudes. Method. A cohort. of students from five U.S. medical schools voluntarily pa rticipated in three surveys longitudinally administered before and after re quired clinical rotations. The first two questionnaires were identical and asked for demographic information and pre-matriculation experiences with ch ronically ill patients. The third was modified to include questions about c linical experiences with chronically ill patients. Responses from the first and third questionnaires were linked for analysis. Results. A total of 502 of 695 students (69%) completed both the first and the third questionnaires. Many students (36%) had had pre-matriculation exp eriences with chronic illness. After clinical training, 25% of the responde nts stated that they would seek another career specialty if the incidence o f chronically ill patients in, creased in their chosen field, compared with the 9% who responded so before clinical training (p < .001). While 73% of the students had favorable perceptions toward chronically ill patients, and 91% felt involved in care, significantly fewer students (p < .01) had had positive patient care experiences when working with residents (57%) and att endings (59%). Gender, age, prior experiences, and school site were not ass ociated with attitudinal changes. Conclusion. Students begin medical school with positive attitudes toward ca ring for chronically ill patients, but this perception depreciates with cli nical experience, which may affect specialty decisions. Contributing factor s may include adequate role modeling by residents and attendings and a perc eived discrepancy in the quality of care patients receive.