Medical students' attitudes towards cancer: influence of the type of clerkship experience

Attitudes of third-year medical students relative to patients with cancer were assessed prior to and following three different 6-week pediatric clerkships. Clerkship I (N = 139) was conducted in a public hospital where student contact with all patients occurred in wards, supervised by pediatricians in all subspecialties. Clerkship II (N = 146) was in a pediatric hospital which is a cancer center. Contact with patients with cancer was directed by oncologists and nononcologists. Clerkship III (N = 31) was similar to II, with an exposure to an oncology ward. A 51-item instrument, employing a visual analog scale, which included general, adult, and pediatric items, was used (pre- & postclerkship) to evaluate attitudes in all 316 students and 49 faculty instructors associated with the clerkships. Factor analysis of student responses to pediatric items resulted in four factors: a) early diagnosis, b) aggressive therapy, c) long-range surveillance, and d) psychosocial support in reference to patients with cancer. Post-test differences between clerkship groups in items a and b were noted, with increasing positivity correlated with increased exposure to oncology and oncologists. Attitudes of faculty nononcologists differed significantly from those of oncologists irrespective of institutional affiliation.