December 2006

Grant Results

SUMMARY

In 2002, researchers at the American Medical Student Association conducted a survey of a national sample of first- and fourth-year medical students that revealed that a majority believe that the U.S. health care system treats people unfairly based on their racial or ethnic background, insurance status, income and native language.

The survey asked students about their knowledge and attitudes about health care delivery and problems with access to health care, including those related to race and ethnicity.

The American Medical Student Association is the oldest and largest independent association of physicians-in-training in the United States.

Key Findings
The researchers reported these findings and others (see Findings) in posters presented by principal investigator Huebner at the 2003 American Medical Student Association Convention:

  • Majorities of both first and fourth-year students believe that the U.S. health care system treats people unfairly based on their:
    • Racial or ethnic background (59.7 percent of first-year and 50.5 percent of fourth-year students).
    • Insurance status (84.7 percent of first-years and 76.9 percent of fourth-years).
    • Income (77.4 percent of first-years and 60.5 percent of fourth-years).
    • Native language (80.7 percent of first-years and 72.2 percent of fourth-years).
  • A majority (50.3 percent) of first-year medical students believes that racial and ethnic background affects an individual's ability to get routine medical care, but only 39.9 percent of fourth-year students agree.
  • Nearly 90 percent of both first and fourth-year students believe that health care is a right.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $50,000 to support this study.

 See Grant Detail & Contact Information
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RWJF STRATEGY

The quality of health care many Americans receive continues to vary depending upon their race or ethnicity, and is frequently unrelated to their income or whether they have health insurance. This project supports RWJF's strategic objective to develop and demonstrate interventions to reduce or eliminate racial and ethnic disparities in the care of targeted diseases.

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THE PROJECT

Jeffrey Huebner, M.D., Jack Rutledge Fellow at the American Medical Student Association, and Jaya Agrawal, a Brown University medical student and 2001–2002 American Medical Student Association president, served as principal investigators. A panel of three expert advisers provided study oversight. (See the Appendix for a list of advisers.) The Center for Survey Research at the University of Virginia administered the written survey, which contained both original and previously published questions.

The survey documented medical students' knowledge about health care access and delivery in the United States, in order to help the association and others direct future medical education reform efforts. The survey also examined differences in knowledge and attitudes between first- and fourth-year students.

University of Virginia medical students pilot-tested the survey before its distribution in March 2002 to a national random sample of 640 first-year and 960 fourth-year medical students. According to the researcher, the survey over-sampled fourth-year medical students, who typically are more difficult to reach. The survey period ended in May 2002, with an overall response rate of 57 percent.

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FINDINGS

The researchers reported these findings in posters presented by principal investigator Huebner at the 2003 American Medical Student Association Convention:

  • Majorities of both first and fourth-year students believe that the U.S. health care system treats people unfairly based on a variety of conditions:
    • Racial or ethnic background (59.7 percent of first-year and 50.5 percent of fourth-year students).
    • Insurance status (84.7 percent of first-years and 76.9 percent of fourth-years).
    • Income (77.4 percent of first-years and 60.5 percent of fourth-years).
    • Native language (80.7 percent of first-years and 72.2 percent of fourth-years).
  • A majority (50.3 percent) of first-year medical students believes that racial and ethnic background affects an individual's ability to get routine medical care, but only 39.9 percent of fourth-year students agree.
  • Nearly 90 percent of both first and fourth-year students believe that health care is a right.
    • Majorities of both classes (70 percent of first-year and 61 percent of fourth-year) support the establishment of universal health care.
    • Only 20 percent of the respondents believe that older physicians support universal health care.
    • Over 80 percent believe that the public favors some form of universal health care.
  • More than 90 percent of both first and fourth-year medical students surveyed said that an understanding of health policy, health care delivery and options for health care reform was important to their future practice of medicine and that the medical school curriculum should allow more time to study these topics.
  • Medical school curricula adequately address cultural sensitivity and racial and ethnic disparities in health care access, according to 63 percent of first-year students and 58 percent of fourth-year students. Nevertheless, nearly 80 percent of first-year and 65 percent of fourth-year students want more exposure to these issues.
  • Both first and fourth-year students exhibited similar levels of knowledge about health care issues. Ninety percent in each class correctly answered over one-half of 11 true/false questions, but majorities in each class exhibited knowledge gaps about the international ranking of the U.S. health care system and details about the uninsured population.
  • The first-year medical students surveyed appeared more idealistic than the fourth-year students did, the researcher said. First-year students were more likely than fourth-year students to favor health care reforms and to acknowledge deficiencies in the U.S. health care system.

Communications

Principal investigator Huebner made poster presentations at the 2003 American Medical Student Association Convention and won the poster competition in the medical education category. The investigators collaborated with researchers from the University of California at San Francisco on a paper submitted to Academic Medicine that includes data from this project along with other survey data. The association Web site includes a summary of the survey findings.

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AFTER THE GRANT

The grantee submitted a follow-up proposal to RWJF, which was turned down, and has received a grant from the federal Agency for Healthcare Research and Quality to conduct a preconference on disparities prior to the organization's annual meeting in March 2004. The investigators plan to complete papers reporting project findings. The grantee continues to address issues of universal health care and disparities in health care access. Some of the data has been and will be used in association press releases to raise awareness about issues pertaining to health care access and disparities, such as Cover the Uninsured week in March.

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GRANT DETAILS & CONTACT INFORMATION

Project

Assessing Medical Students' Knowledge and Attitudes of Health Care Access Issues

Grantee

American Medical Student Association Foundation (Reston,  VA)

  • Amount: $ 50,000
    Dates: September 2001 to August 2002
    ID#:  042706

Contact

Joan Hedgecock, M.S.P.H.
(703) 620-6600
joan_h@www.amsa.org

Web Site

http://www.amsa.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Project Advisers

Paul Jung, M.D.
Robert Wood Johnson Foundation Clinical Scholar
Johns Hopkins University

Ashwini Sehgal, M.D.
MetroHealth
Case Western Reserve Medical School

Steven Simon, M.D., M.P.H.
Harvard Pilgrim Health Care
Harvard Medical School

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Wilson E, Grumbach K, Huebner J, Agrawal J and Bindman AB. "Medical Student, Physician, and Public Perceptions of Health Care Disparities." Family Medicine, 36(10): 715–721, 2004. Abstract available online.

Reports

Huebner J. 2002 AMSA Foundation American Health Care System Survey — Executive Summary. Reston, Va.: American Medical Student Association Foundation, 2002. Also appears online.

Survey Instruments

"2002 American Health Care System Survey," American Medical Student Association Foundation, fielded March–May 2002.

Presentations and Testimony

Jeffrey Huebner, "An Assessment of Medical Students' Views About Health Policy and Its Inclusion in the Curriculum," poster abstract at the American Medical Student Association Convention, March 20, 2003, Crystal City, Va.

Jeffrey Huebner, "Medical Students' Knowledge and Beliefs About Health Policy Issues, Including Universal Health Care," poster abstract at the American Medical Student Association Convention, March 20, 2003, Crystal City, Va.

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Report prepared by: Mary B. Geisz
Reviewed by: Richard Camer
Reviewed by: Marian Bass
Program Officer: Risa Lavizzo-Mourey