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Looking to the Future

Medical Students’ Views on Health Care Reform and Professional Responsibility

Rook, Jordan M.; Winkelman, Tyler N.A., MD, MSc; Fox, Jacob A.; Pierce, Jacob B.; Oot, Antoinette R.; Blum, James R.; Feuerbach, Alec M.; Shahu, Andi, MD, MHS; Goldman, Max L., MD; Kopp, Zoe, MD; Duffy, Eamon, MD, MBA; Robledo-Gil, Talia, MD; Tran, Nhi, MD, MPH; Davey, Cynthia S., MSc; Henschen, Bruce L., MD, MPH

doi: 10.1097/ACM.0000000000002621
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Purpose: Although medical students will influence the future U.S. health care system, their opinions on the Patient Protection and Affordable Care Act (ACA) have not been assessed since the 2016 presidential election and elimination of key ACA provisions. Understanding medical students’ views on health care policy and professional obligations can provide insight into issues that will be shaped by the next generation of physicians.

Method: From October 2017 to November 2017, the authors conducted an electronic survey of medical students from seven U.S. institutions to elicit opinions regarding the ACA and their professional responsibility to address health policy. Participant demographics and responses were tabulated, and multiple logistic regression models were used to assess the associations of demographic characteristics with student opinions.

Results: Completed surveys were returned by 1,660/4,503 (36.9%) eligible medical students. Respondent demographics were similar to national estimates. In total, 89.1% (1,475/1,660) supported the ACA, and 82.0% (1,362/1,660) reported they understood the health care law. Knowledge of the law’s provisions was positively associated with support for the ACA (P < .001). Most students (85.8%; 1,423/1,660) reported addressing health policy to be a professional responsibility. Political affiliation was consistently associated with student opinions.

Conclusions: Most medical students support the ACA, with greater levels of support among medical students who demonstrated higher levels of objective knowledge about the law. Furthermore, students indicated a professional responsibility to engage in health policy, suggesting tomorrow’s physicians are likely to participate in future health care reform efforts.

J.M. Rook is a fourth-year medical student, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

T.N.A. Winkelman is a clinician-investigator, Hennepin Healthcare, Minneapolis, Minnesota.

J.A. Fox is a fourth-year medical student, University of Colorado School of Medicine, Denver, Colorado.

J.B. Pierce is a third-year medical student, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

A.R. Oot is a third-year medical student, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

J.R. Blum is a third-year medical student, Icahn School of Medicine at Mount Sinai, New York, New York.

A.M. Feuerbach is a fourth-year medical student, Icahn School of Medicine at Mount Sinai, New York, New York.

A. Shahu is a first-year resident in internal medicine, Johns Hopkins Hospital, Baltimore, Maryland.

M.L. Goldman is a first-year resident in internal medicine, University of California San Francisco, San Francisco, California.

Z. Kopp is a first-year resident in internal medicine, University of California San Francisco, San Francisco, California.

E. Duffy is a first-year resident in internal medicine, Johns Hopkins Hospital, Baltimore, Maryland.

T. Robledo-Gil is a first-year resident in internal medicine and urban health, Johns Hopkins Hospital, Baltimore, Maryland.

N. Tran is a first-year resident in family medicine, University of California San Francisco, San Francisco, California.

C.S. Davey is a biostatistician, University of Minnesota Clinical and Translational Science Institute, Minneapolis, Minnesota.

B.L. Henschen is an assistant professor, Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A637.

Acknowledgments: The authors wish to thank the mentors at each participating school including Dr. John Hughes, Dr. Erik Wallace, Dr. Meredith Lora, Dr. Ann-Gel Palermo, and Dr. Tonya Fancher. Thanks are also extended to Dr. Priscilla Wang who helped develop this project.

Funding/Support: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1- TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Other disclosures: None reported.

Ethical approval: Institutional review board approval of study exemption was obtained at all seven participating institutions.

Previous presentations: Poster presentation on March 29, 2018, at the Society of General Internal Medicine’s 2018 annual conference. Oral presentation on October 1, 2018, at the American College of Emergency Physicians Research Forum. Oral presentation on October 23, 2018, at the American College of Surgeons Clinical Congress.

Correspondence should be addressed to Jordan M. Rook, Ward Building, 303 East Chicago Ave., Suite 1-003, Chicago, IL, 60611-3008; telephone: (312) 503-8194; email: jordan.rook@northwestern.edu.

© 2019 by the Association of American Medical Colleges