US Medical Students Research Articles

A Longitudinal Study of Differences in Canadian and US Medical Student Preparation for Family Medicine

Background and Objectives: Previous research has found differences in preparation for entry into family medicine training between graduates of US and Canadian medical schools. However, this research was limited in that it utilized cross-sectional data to examine a longitudinal issue. This study aimed to examine these differences with a longitudinal data set. Methods: A comparison of the performance on the American Board of Family Medicine (ABFM) In-Training Exam (ITE) between 2014 and 2016 was conducted by examining the performance of Canadian medical school graduates and US medical school graduates longitudinally, as well as cross-sectionally, using independent t tests. Results: For first-year residents (PGY1), the Canadian 2014/2015 cohort showed significantly higher mean scores than US medical school graduates (USMG) and international medical school graduates (IMG). The Canadian 2015/2016 cohort showed no statistical difference from the USMGs, but did have a significantly higher mean than the IMGs. For second-year residents (PGY2), the Canadian 2014/2015 cohort showed a significantly lower mean than the USMG cohort, but had a significantly higher mean than the IMG cohort. The Canadian 2015/2016 cohort showed a statistically lower mean than the USMG cohort and no difference compared to the IMG cohort. Conclusions: Based on a comparison of ABFM ITE scores between 2014 and 2016, the Canadian medical school graduates performed as well as or better than the US graduates upon entry into residency, but performance was reversed for the second year of training. Our results also suggest an equity value of ACGME residency training independent of location of undergraduate medical training.

The Potential Impact of Morality on Medical Student Global Health Participation

Interest in global health experiences (GHEs) has surged in the last decade throughout undergraduate medical education. Positive clinical and cultural learning impacts are well described; however, the moral and motivational typology of the globally minded medical student are yet to be elucidated. We surveyed 85 US medical students, 41 who participated in a GHE during medical school and 44 who did not, to examine their sense of moral association with local community, Americans, and all of humanity. Measures of empathy and spirituality were also administered, as well as a qualitative prompt to elicit reasons for participating, or not, in a GHE. The results of logic regression analysis suggest that the strongest predictors of GHE participation are strong, geographically non-specific identification with ‘all humanity’ [OR=1.31, P<0.01, 95% CI, 1.07–1.59], as well as participation in an abroad experience prior to medical school [OR 141, P<0.01, 95% CI, 10.1–1960]. While respondent groups did not differ significantly in their association with local community, incremental increase in identification with ‘Americans’ decreased likelihood of IME participation by 20% [P=0.02, 95% CI, 0.67–0.96]. No significant effect was found between participant groups in response to empathy or spirituality scales. This pilot study demonstrates that a global regard for ‘all humanity’ may motivate GHE participation while a strong national association diminishes its likelihood.

Mentorship of US Medical Students: a Systematic Review.

Mentoring of medical students remains a core pillar of medical education, yet the changing landscape of medicine has called for new and innovative mentoring models to guide students in professional development, career placement, and overall student well-being. The objective of this review is to identify and describe models of mentorship for US medical students. We searched PubMed, PsycINFO, Education Resources Information Center, and Cochrane Databases of Systematic Reviews following PRISMA guidelines. We included original, English-language studies of any research design including descriptive studies that described a mentorship program at a US medical school designed for medical students. Our search yielded 3743 unique citations. Thirty articles met our inclusion criteria. There was significant diversity of the identified programs with regard to program objectives and size. The traditional dyad model of mentorship was the most frequently cited model, with a combination of models (dyad and group mentorship) cited as the second most common. Outcome measures of the programs were largely survey based, with satisfaction being the most measured outcome. Overall, satisfaction was highly rated throughout all the measured mentoring programs. Seven programs provided objective outcomes measures, including improved residency match data and increased scholarly productivity. The programs with objective outcomes measures were smaller, and 6/7 of them focused on a specific clinical area. Five of these programs relied on the traditional dyad model of mentorship. Cost and faculty time were the most frequently cited barriers to these programs. Our review demonstrates that mentoring programs for medical students can positively improve medical school satisfaction and career development. These results underscore the need for continued innovative mentoring programs to foster optimal student development in the setting of the increasingly competitive residency match process, growing expectations about student research productivity, and the national focus for overall student wellness.

Trends in Racial/Ethnic Representation Among US Medical Students

With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines. To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population. Repeated cross-sectional study of Association of American Medical Colleges data on self-reported race/ethnicity and sex of medical school applicants and matriculants compared with population distribution of the medical school-aged population (20-34 years). Data from US allopathic medical school applicants and matriculants from 2002 to 2017 were analyzed. Trends were measured using the representation quotient, the ratio of the proportion of a racial/ethnic group in the medical student body to the general age-matched US population. Linear regression estimates were used to evaluate the trend over time for Asian, black, white, Hispanic, American Indian or Alaska Native (AIAN), and Native Hawaiian or Other Pacific Islander medical school matriculants by sex. The number of medical school applicants increased 53%, from 33 625 to 51 658, and the number of matriculants increased 29.3%, from 16 488 to 21 326, between 2002 and 2017. During that time, proportions of black, Hispanic, Asian, and Native Hawaiian or Other Pacific Islander male and female individuals aged 20 to 34 years in the United States increased, while proportions of white male and female individuals decreased and proportions of AIAN male and female individuals were stable. From 2002 to 2017, black, Hispanic, and AIAN applicants and matriculants of both sexes were underrepresented, with a significant trend toward decreased representation for black female applicants from 2002 to 2012 (representation quotient slope, -0.011; 95% CI, -0.015 to -0.007; P < .001). Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the US population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the US population.

New Allopathic Medical Schools and Family Physicians.

In 2018 the 8 national family medicine organizations set a goal of having 25% of graduating US medical students choose family medicine as their specialty by 2030 (25 × 2030 campaign).[1][1] If current trends continue, this goal will not be met, as only 9.3% of graduating allopathic medical students

The Family Medicine Attitudes Questionnaire: A Valid Instrument to Assess Student Attitudes Toward Family Medicine.

Medical student attitudes toward family medicine influence student likelihood of choosing family medicine and the US primary care physician workforce. We sought to refine and assess the validity of the Family Medicine Attitudes Questionnaire, an instrument that assesses student attitudes toward family medicine in US medical students. A 24-item questionnaire, including items assessing students' attitudes toward family medicine's importance, family physician shortage, family medicine research, family systems, family physicians' expertise, and lifestyle, was offered to fourth-year students at 16 US medical schools. We evaluated the questionnaire's content validity, construct validity, and criterion validity. Content validity was assessed using a qualitative approach to direct observation, construct validity by data reduction and iterative factor analyses, and criterion validity by correlating items with intention to match into family medicine. The questionnaire was completed by 1,188 (44.9%) of 2,644 students invited to complete it; 10 items were removed in the validation process. The final 14-item instrument had a Cronbach α of 0.767. Total score correlated with family medicine specialty choice (P&lt;.001). A questionnaire score of 56 or higher is 78.1% sensitive and 65.3% specific for identifying students who intend to match into family medicine. In regression analysis, questionnaire score was an independent predictor of choosing family medicine (odds ratio 1.289, confidence interval 1.223-1.347). The Family Medicine Attitudes Questionnaire is a valid instrument for assessing US medical student attitudes toward family medicine. This tool will help educators assess the impact of curricular and policy interventions designed to promote family medicine specialty choice.

Trends in US Medical School Contributions to the Family Physician Workforce: 2018 Update From the American Academy of Family Physicians.

The United States needs more family physicians. Projections based on current trends show a deficit of 52,000 primary care physicians by 2025. Eight national family medicine (FM) organizations have set an ambitious goal of increasing the proportion of US medical school graduates who enter FM residencies to 25% by 2030. This paper describes the most recent number and percentage of students from each US medical school entering Accreditation Council for Graduate Medical Education (ACGME)-accredited FM residency programs, long-term trends in the contribution of allopathic and osteopathic medical schools to the FM workforce, and medical school characteristics associated with higher proportions of FM graduates. Data about graduates entering US ACGME-accredited FM residency programs were collected using an annual program census and supplemental sources. Longitudinal census data from allopathic and osteopathic schools were combined to examine trends over time. ANOVA analyses were conducted to compare schools by percent of graduates entering FM, public/private ownership, allopathic/osteopathic, size, and presence of FM department. Medical school length of operation was correlated with percentage of students entering FM. The overall proportion of US students entering ACGME-accredited FM programs has increased modestly over the past decade. Currently, only 12.6% of US allopathic and osteopathic seniors enter ACGME-accredited FM programs. Individual medical schools' contributions to the FM workforce are described. The proportion of US medical students beginning ACGME-accredited FM residency programs has increased slightly over the last decade. However, significant changes to undergraduate medical education are needed to meet the nation's primary care needs.

Sex and Racial/Ethnic Diversity of US Medical Students and Their Exposure to Dermatology Programs

This study characterizes sex and racial/ethnic discrepancies in exposure to dermatology among US medical students.

977. An Innovative 3-Year Medical Student Spiral Curriculum in Antimicrobial Stewardship and Infectious Diseases

BackgroundBy 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns.MethodsWe designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training.ResultsUsing GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training.ConclusionA spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians.Disclosures All authors: No reported disclosures.

Factors influencing medical student self-competence to provide weight management services.

This study aimed to identify factors associated with high obesity care self-competence among US medical students. The authors performed a cross-sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self-competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self-competence in caring for patients with obesity. Factors associated with high self-competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self-competence in providing obesity-related care to patients. Medical schools might consider increasing partnership skills training to improve students' preparedness and skill in performing obesity-related care.

Commentary: Trends in the National Resident Matching Program (NRMP) Data for Graduating US Medical Students Matching in Neurosurgery.

Commentary: Trends in the National Resident Matching Program (NRMP) Data for Graduating US Medical Students Matching in Neurosurgery.

Investigating US medical students' motivation to respond to lapses in professionalism.

ContextAs unprofessional behaviour in physicians can compromise patient safety, all physicians should be willing and able to respond to lapses in professionalism. Although students endorse an obligation to respond to lapses, they experience difficulties in doing so. If medical educators knew how students respond and why they choose certain responses, they could support students in responding appropriately.ObjectivesThe aim of this study was to describe medical students' responses to professionalism lapses in peers and faculty staff, and to understand students' motivation for responding or not responding.MethodsWe conducted an explorative, qualitative study using template analysis, in which three researchers independently coded transcripts of semi‐structured, face‐to‐face interviews. We purposefully sampled 18 student representatives convening at a medical education conference. Preliminary open coding of a data subset yielded an initial template, which was applied to further data and modified as necessary. All transcripts were coded using the final template. Finally, three sensitising concepts from the Expectancy–Value–Cost model were used to map participants' responses.ResultsStudents mentioned having observed lapses in professionalism in both faculty staff and peers. Students' responses to these lapses were avoiding, addressing, reporting or initiating policy change. Generally, students were not motivated to respond if they did not know how to respond, if they believed responding was futile and if they feared retaliation. Students were motivated to respond if they were personally affected, if they perceived the individual as approachable and if they thought that the whole group of students could benefit from their actions. Expectancy of success, value and costs each appeared to be influenced by (inter)personal and system factors.ConclusionsThe Expectancy–Value–Cost model effectively explains students' motivation for responding to lapses. The (inter)personal and system factors influencing students' motivation to respond are modifiable and can be used by medical educators to enhance students' motivation to respond to lapses in professionalism observed in medical school.

Analysis of the 1990-2007 neurosurgery residency match: does applicant gender affect neurosurgery match outcome?

OBJECTIVE With nearly half of graduating US medical students being female, it is imperative to understand why females typically make up less than 20% of the neurosurgery applicant pool, a number that has changed very slowly over the past several decades. Organized neurosurgery has strongly indicated the desire to overcome the underrepresentation of women, and it is critical to explore whether females are at a disadvantage during the residency application process, one of the first steps in a neurosurgical career. To date, there are no published studies on specific applicant characteristics, including gender, that are associated with match outcome among neurosurgery resident applicants. The purpose of this study is to determine which characteristics of neurosurgery residency applicants, including gender, are associated with a successful match outcome. METHODS De-identified neurosurgical resident applicant data obtained from the San Francisco Fellowship and Residency Matching Service for the years 1990-2007 were analyzed. Applicant characteristics including gender, medical school attended, year of application, United States Medical Licensing Exam (USMLE) Step 1 score, Alpha Omega Alpha (AOA) status, and match outcome were available for study. RESULTS Of the total 3426 applicants studied, 473 (13.8%) applicants were female and 2953 (86.2%) were male. Two thousand four hundred forty-eight (71.5%) applicants successfully matched. USMLE Step 1 score was the strongest predictor of match outcome with scores > 245 having an OR of 20.84 (95% CI 10.31-42.12) compared with those scoring < 215. The mean USMLE Step 1 score for applicants who successfully matched was 233.2 and was 210.8 for those applicants who did not match (p < 0.001). Medical school rank was also associated with match outcome (p < 0.001). AOA status was not significantly associated with match outcome. Female gender was associated with significantly lower odds of matching in both simple (OR 0.59, 95% CI 0.48-0.72) and multivariate analyses (OR 0.57, 95% CI 0.34-0.94 CI). USMLE Step 1 scores were significantly lower for females compared to males with a mean score of 230.1 for males and 221.5 for females (p < 0.001). There was no significant difference in medical school ranking or AOA status when stratified by applicant gender. CONCLUSIONS The limited historical applicant data from 1990-2007 suggests that USMLE Step 1 score is the best predictor of match outcome, although applicant gender may also play a role.

Representation of Women on Radiology Journal Editorial Boards: A 40-Year Analysis

We examined female representation on editorial boards of four prominent radiology journals. We compared editorial board representation to female academic radiology career advancement and the proportion of female authorship in three journals over four decades. We collected data on the gender of editorial board members as listed on mastheads of Radiology, American Journal of Roentgenology (AJR), Academic Radiology, and the Journal of the American College of Radiology in 5-year intervals plus the most recent year available (1973-2017), and the gender of their editors-in-chief for all years since each journal's inception. We compared Radiology, AJR, and Academic Radiology data to published data on gender of the journals' authors, all US medical students, and academic radiologists over time. Gender was determined for 171 editors-in-chief (100%) and 2139 (100%) editorial board members listed in the selected journals for each of the study years. The proportion of women on editorial boards increased from 1.4% (1 of 69) in 1978 to 18.8% (73 of 388) in 2013 (P < .001), but remained below the proportion of female first authors (7.5% in 1978 and 27.1% in 2013) and female faculty in radiology (11.5% in 1978 and 28.1% in 2013). None of the four general radiology journals had a female editor-in-chief during the study period. Female representation on editorial boards has increased over time, but still lags behind increases seen in female first authorship in radiology journals and radiology faculty appointments over the last four decades. There was no female editor-in-chief during the study period.

Choosing emergency medicine: Influences on medical students' choice of emergency medicine.

BackgroundRelatively little is understood about which factors influence students’ choice of specialty and when learners ultimately make this decision.ObjectiveThe objective is to understand how experiences of medical students relate to the timing of selection of Emergency Medicine (EM) as a specialty. Of specific interest were factors such as how earlier and more positive specialty exposure may impact the decision-making process of medical students.MethodsA cross-sectional survey study of EM bound 4th year US medical students (MD and DO) was performed exploring when and why students choose EM as their specialty. An electronic survey was distributed in March 2015 to all medical students who applied to an EM residency at 4 programs representing different geographical regions. Descriptive analyses and multinomial logistic regressions were performed.Results793/1372 (58%) responded. Over half had EM experience prior to medical school. When students selected EM varied: 13.9% prior to, 50.4% during, and 35.7% after their M3 year. Early exposure, presence of an EM residency program, previous employment in the ED, experience as a pre-hospital provider, and completion of an M3 EM clerkship were associated with earlier selection. Delayed exposure to EM was associated with later selection of EM.ConclusionsEarly exposure and prior life experiences were associated with choosing EM earlier in medical school. The third year was identified as the most common time for definitively choosing the specialty.

Teaching Medical Students Clinical Anesthesia.

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.

Positive predictive value of medical student specialty choices

BackgroundAlthough medical school programs oriented toward postgraduate specialty training have the potential to reduce the duration and cost of medical school for US medical students, success depends on the ability of students to predict their postgraduate specialties. It is clear that first-year choices are poorly predictive, but it is not known when predictions become sufficiently reliable to support specialty-oriented learning programs. We therefore examined the predictive value of specialty preferences expressed at the ends of the first, second and third years of medical school and asked whether concurrent expressions of confidence in choices improved predictive ability. We also investigated the possibility that discrepancies between predicted and actual postgraduate specialty training were related to scores on an examination of knowledge in basic biomedical sciences required for US medical school graduation (the United States Medical Licensing Examination (USLME) Step 1 examination).MethodWe calculated positive and negative predictive values (PPV and NPV, respectively) for specialty choices and the sensitivity and specificity of asking for choices for 634 University of Colorado School of Medicine students who trained in 23 accredited residencies from 2011 through 2015. We examined the effect of confidence in first choices in 609 students, and in 334 students, sought an association between USMLE Step 1 scores and switching from postgraduate training specialties predicted at the end of year 2.ResultsThe PPV of first choices improved from years 1 through 3. NPV was high throughout. PPVs of year 3 first choices ranged from 79% in Anesthesiology to 95% in Psychiatry. Expressions of confidence in first choices did not improve PPV. Sensitivity of asking for first choices increased with time; specificity was consistently high. USLME Step 1 scores were higher for students who ultimately trained in specialties more competitive than first-choice specialties at the end of year 2.ConclusionsSpecialty-oriented learning programs during medical school must accommodate students who change career plans. The PPV of specialty first choices improves each year, but even year 3 predictions can be inaccurate with potential loss of students from specialty-specific programs. USMLE Step 1 scores appeared to affect career plans expressed at the end of year 2.

Defining Medical Student Patient Care Responsibilities Before Intern Year: Results of a National Survey.

Program directors have noted that first-year residents struggle with many of the patient care responsibilities they assume as they enter the US graduate medical education system. A national description of medical students' patient care experience in advance of graduation has not been published. We sought to describe the experience of US medical students during their clinical training by surveying the student representatives of each school. We developed a mixed-methods survey that was delivered to representatives of 82 schools via an e-mail link to an online survey. Our response rate was 54% (44/82). Of those responding, 28% reported that students do not write any patient care orders at their institution and 34% reported not receiving pages related to patient care. Only 26% of institutions provide an increased patient load to students during their final year of training. Students identified many areas to improve the role of fourth-year medical students, including writing patient care orders, answering pages, increasing autonomy, defining their role better, and providing them with a longer subinternship experience. Our survey suggests that students are graduating from the undergraduate medical education system and moving to the graduate medical education system in the United States without a guarantee of having answered a page related to patient care or having placed a patient care order. Further studies of students' experiences should be conducted to explore whether exposure to these skills improves first-year resident performance.

A Closer Look at Racism and Heterosexism in Medical Students' Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education.

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.

Social preferences of future physicians

We measure the social preferences of a sample of US medical students and compare their preferences with those of the general population sampled in the American Life Panel (ALP). We also compare the medical students with a subsample of highly educated, wealthy ALP subjects as well as elite law school students and undergraduate students. We further associate the heterogeneity in social preferences within medical students to the tier ranking of their medical schools and their expected specialty choice. Our experimental design allows us to rigorously distinguish altruism from preferences regarding equality-efficiency tradeoffs and accurately measure both at the individual level rather than pooling data or assuming homogeneity across subjects. This is particularly informative, because the subjects in our sample display widely heterogeneous social preferences in terms of both their altruism and equality-efficiency tradeoffs. We find that medical students are substantially less altruistic and more efficiency focused than the average American. Furthermore, medical students attending the top-ranked medical schools are less altruistic than those attending lower-ranked schools. We further show that the social preferences of those attending top-ranked medical schools are statistically indistinguishable from the preferences of a sample of elite law school students. The key limitation of this study is that our experimental measures of social preferences have not yet been externally validated against actual physician practice behaviors. Pending this future research, we probed the predictive validity of our experimental measures of social preferences by showing that the medical students choosing higher-paying medical specialties are less altruistic than those choosing lower-paying specialties.