Evidence of professional values in a rural medical education program: Implications for medical education leaders

摘要

Medical education leaders have been concerned about the decline in professionalism among medical students. While many studies have documented the professional socialization of medical students most have simply noted the process or examined the adaptation on the part of the students to the environment of the academic health center. Few have examined the socialization of professionalism, although many articles in the literature have discussed the lack of professionalism seen among medical students and they progress through their medical education. This is seen in students' distancing from patients, adopting the use of dehumanizing terminology when referring to patients and their families, and the decline in psycho-social functioning. There appear to be many factors that have facilitated this decline in professional values. Some include the increasing involvement of managed care in the teaching hospital, requirements for faculty to increase their clinical revenue thus reducing their time spent with students, and relegation of the teaching of medical students to residents. This study examines an alternate environment, the rural site, as one that may favor the adoption of the traditional or core professional values of physicians. This research qualitatively examines student's comments related to their involvement in a rural medical education program. This program, which selects 15 students each year from the entering class of medical students, seeks to nurture interest in rural practice. These medical students appear to have increased exposure to professional values due to their increased time spent in the rural environment. These teaching sites provide an alternative with which to compare the values held and reinforced in the academic health center. The values in the rural environments appear to be different than those in the academic health center, and seem to reflect professionalism in ways that are more consistent with the traditional values of physicians. These values include ones such as service to the community, altruism, honesty, respect and collegiality. The professional socialization of medical students requires the socialization of professional values. The rural medical education sites examined here through the students' comments reflect a different type of experience, one in which professional values are modeled, expected and upheld.