The impact of training on physicians' commitment to professional values is examined, using a cohort design to assess the evolution of attitudes toward AIDS during residency training. Cohorts of surgeons training in the same six residency programs were followed at key junctures, and their outlooks on three AIDS-related attitudes were examined: willingness to treat people with AIDS (PWAs), concern about exposure to HIV, and perceived benefits of treating AIDS. The findings revealed a consistent, negative impact of training on all three attitudes. Cohort and period (historical) effects were limited: younger cohorts more often viewed treating PWAs as a clinically valuable experience, and greater concern about exposure was evidenced as training progressed. The findings yield new evidence of the importance of residency training to professional socialization. More knowledge of alterable aspects of residency training that play a role is key to assuring that physicians emerge with a dedication to fulfilling their social responsibilities.
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References
1.
Becker, H. S. , B. Geer, E. Hughes, and A. L. Strauss. Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press, 1961.
2.
Bloom, S. W."Structure and Ideology in Medical Education: An Analysis of Resistance to Change."Journal of Health and Social Behavior29 (1988): 294-306.
3.
Bosk, C.Forgive and Remember. Chicago: University of Chicago Press, 1979.
4.
Bosk, C. L. , and J. E. Frader. "AIDS and Its Impact on Medical Work: The Culture and Politics of the Shop Floor."Milbank Quarterly68 (1990): 257-279.
5.
Bucher, R. , and J. G. Stelling. Becoming Professional. Beverly Hills, CA: Sage, 1977.
6.
Butterfield, P. S."The Stress of Residency: A Review of the Literature."Archives of Internal Medicine148 (1988): 1428-1435.
7.
Colford, J. M. , and S. S. McPhee. "The Unravelled Sleeve of Care: Managing Stresses of Residency Training."Journal of the American Medical Association261 (1989): 889-893.
8.
Conrad, P."Learning to Doctor: Reflections on Recent Accounts of the Medical School Years."Journal of Health and Social Behavior29 (1988): 323-332.
9.
Cousins, N."Internship: Preparation or Hazing?Journal of the American Medical Association245 (1981): 377.
10.
Curry, C. J. , M. Johnson, and B. Ogden. "Willingness of Health-Professions Students to Treat Patients with AIDS."Academic Medicine65 (1990): 472-474.
11.
Feldman, T. B. , R. A. Bell, J. J. Stephenson, and F. Purifoy"Attitudes of Medical School Faculty and Students toward Acquired Immunodeficiency Syndrome."Academic Medicine65 (1990): 464-466.
12.
Ficarrotto, T. J. , M. Grade, N. Bliwise, and T. Irish. "Predictors of Medical and Nursing Students' Levels of HIV-AIDS Knowledge and Their Resistance to Working with AIDS Patients."Academic Medicine65 (1990): 470-471.
13.
Fox, R. C."Training for Uncertainty." In The Student Physician, edited by R. K. Merton, G. G. Reader, and P. C. Kendall, 207-241. Cambridge, MA: Harvard University Press, 1957.
14.
Friedman, R. C. , T. Bigger, and D. S. Kornfield. "The Intern and Sleep Loss."New England Journal of Medicine285 (1971): 201-203.
15.
Gann, P. H. , S. Anderson, and M. B. Regan. "Shifts in Medical Student Beliefs about AIDS after a Comprehensive Training Experience."American Journal of Preventive Medicine7 (1991): 172-177.
16.
Gerberding, J. L. , C. Littel, A. Tarkington, A. Brown, and W. P. Schecter. "Risk of Exposure to Patients' Blood during Surgery at San Francisco General Hospital."New England Journal of Medicine322 (1990): 1788-1793.
17.
Gerbert, B. , B. T. Maguire, T. Bleecker, T. J. Coates, and S. J. McPhee. "Primary Care Physicians and AIDS: Attitudinal and Structural Barriers to Care."Journal of the American Medical Association266 (1991): 2837-2842.
18.
Gerbert, B. , B. McGuire, V. Badner, D. Altman, and G. Stone. "Why Fear Persists: Health Care Professionals and AIDS."Journal of the American Medical Association260 (1988): 3481-3483.
19.
Gillon, R."Refusal to Treat AIDS and HIV Positive Patients."British Medical Journal294 (1987): 1332-1333.
20.
Glenn, N. G.Cohort Analysis. Beverly Hills, CA: Sage, 1984.
21.
Granich, R. , and J. Mermin. "Students' Attitudes about AIDS."Annals of Internal Medicine114 (1991):1066.
22.
Greater New York Hospital Association . Survey of Average Daily Census of Hospitalized Patients with AIDS. Unpublished data, Greater New York Hospital Association, 1989.
23.
Hagen, M. D. , K. S. Meyer, and S. G. Pauker. "Routine Preoperative Screening for HIV: Does the Risk to the Surgeon Outweigh the Risk to the Patient?"Journal of the American Medical Association259 (1988): 1357-1359.
24.
Hayward, R. A. , and M. F. Shapiro. "A National Study of AIDS and Residency Training: Experiences, Concerns, and Consequences."Annals of Internal Medicine114 (1991): 23-32.
25.
Kim J. H. , and J. R. Perfect. "To Help the Sick: An Historical and Ethical Essay concerning the Refusal to Care for Patients with AIDS."American Journal of Public Health84 (1988): 135-138.
26.
Link, R. N. , A. R. Feingold, M. H. Charap, K. Freeman, and S. P. Shevlov. "Concerns of Medical and Pediatric House Officers about Acquiring AIDS from Their Patients."American Journal of Public Health78 (1988): 455-459.
27.
Loewy, E. H."Duties, Fears and Physicians."Social Science and Medicine22 (1986): 1363-1366.
28.
Loewy, E. H. . "Risk and Obligation: Health Professionals and the Risk of AIDS."Death Studies12 (1988): 531-545.
29.
Marcus, R."CDC Cooperative Needle Stick Surveillance Group: Surveillance of Health Care Workers Exposed to Blood from Patients Infected with the Human Immunodeficiency Virus."New England Journal of Medicine319 (1988): 1118-1123.
30.
McCue, J. D."The Distress of Internship: Causes and Prevention."New England Journal of Medicine312 (1985): 449-452.
31.
Merton, R. K. , G. G. Reader, and P. C. Kendall, eds. The Student Physician: Introductory Studies in the Sociology of Medical Education. Cambridge, MA: Harvard University Press, 1957.
32.
Mizrahi, T.Getting Rid of Patients: Contradictions in the Socialization of Physicians. New Brunswick, NJ: Rutgers University Press, 1986.
33.
Mumford, E.Interns: From Students to Physicians. Cambridge, MA: Harvard University Press, 1970.
34.
Nerenz, D. , H. Rosman, C. Newcomb, M. Bolton, G. Heudebert, T. Simmer, and S. Goldstein. "The On-Call Experience of Interns in Internal Medicine."Archives of Internal Medicine150 (1990): 2294-2297.
35.
New York City Health and Hospitals Corporation . One-Week Average Daily Census. Unpublished data, New York City Health and Hospitals Corporation, 1989.
36.
Olesen, V."Caregiving, Ethical and Informal: Emerging Challenges in the Sociology of Health and Illness."Journal of Health and Social Behavior30 (1989): 1-10.
37.
Shapiro, M. F. , R. A. Hayward, D. Guillemot, and D. Jayle. "Residents' Experiences in, and Attitudes toward, the Care of Persons with AIDS in Canada, France, and the United States."Journal of the American Medical Association268 (1992): 510-515.
38.
Smith, J. W. , W. F. Denny, and D. B. Witzke. "Emotional Impairment in Internal Medicine House Staff: Results of a National Survey."Journal of the American Medical Association255 (1986): 1155-1158.
39.
Smith, T."AIDS: A Doctor's Duty."British Medical Journal294 (1987): 6.
40.
Strunin, L. , A. Culbert, and S. Crane. "First-Year Medical Students' Attitudes And Knowledge about AIDS."AIDS Care1 (1989): 105-110.
41.
Yedidia, M. J. , J. Barr, and C. Berry. "The Importance of AIDS among Factors Influencing Residency Program Choice."AIDS and Public Policy Journal7 (1992): 128-134.
42.
Yedidia, M. J. , J. Barr, and C. Berry. Physicians' Attitudes toward AIDS at Different Career Stages: A Comparison of Internists and Surgeons."Journal of Health and Social Behavior34 (1993): 272-284.
43.
Yedidia, M. J. , C. Berry, and J. K. Barr. "Changes in Physicians' Attitudes toward AIDS during Residency Training: A Longitudinal Study of Medical School Graduates."Journal of Health and Social Behavior, in press.
44.
Yedidia, M. J. , M. Lipkin, M. D. Schwartz, and C. Hirschkorn. "Doctors as Workers: Work-Hour Regulations and Interns' Perceptions of Responsibility, Quality of Care, and Training."Journal of General Internal Medicine8 (1993): 429-435.
45.
Yellowlees, P. M."Children with the Acquired Immunodeficiency Syndrome."Medical Journal of Australia149 (1988): 175-176.
