1537
Medical Students’ Attitudes Toward Persons With Disability:
A Comparative Study
Raymond C. Tervo, MD, MSc, Scott Azuma, PhD, PT, Glen Palmer, PhD, Pat Redinius, MEd
ABSTRACT. Tervo RC, Azuma S, Palmer G, Redinius P.
Medical students’ attitudes toward persons with disability: a
comparative study. Arch Phys Med Rehabil 2002;83:1537-42.
Objectives: To investigate first-year medical students’ atti-
tudes toward persons with disability and to examine whether
gender and a background in disability determine attitudes to-
ward persons with disability.
Design: A cross-sectional survey.
Setting: University settings in the United States and Canada.
Participants: Ninety first-year medical students (US, n⫽46;
Canada, n⫽44) were surveyed.
Intervention: Medical students given 3 surveys.
Main Outcome Measures: Attitude Toward Disabled Per-
sons (ATDP) Scale, Scale of Attitudes Toward Disabled Per-
sons (SADP), and Rehabilitation Situations Inventory (RSI).
Results: There were no differences between the medical
student groups from the United States and Canada. Compared
with norms, medical students overall have more positive atti-
tudes on the ATDP. Their attitudes were less positive on the
SADP and on its optimism– human rights subscale. On the RSI,
they were less comfortable with sexual situations and depres-
sion. Male medical students held poorer attitudes as scored
than female medical students. Those with a background in
disability were more comfortable dealing with challenging
rehabilitation situations. Comfort with challenging rehabilita-
tion situations showed significant differences across levels of
experience but not gender. The more positive medical students’
attitudes are toward persons with disability, the more likely
they are to be comfortable with challenging rehabilitation sit-
uations.
Conclusion: First-year medical students from the United
States and Canada held similar attitudes and had less positive
attitudes than SADP norms. Gender and background in disabil-
ity influenced attitudes. Male medical students were more
likely to hold negative attitudes. Specific educational experi-
ences need to promote more positive attitudes.
Key Words: Disabled persons; Knowledge, attitudes, prac-
tice; Rehabilitation; Students, medical.
© 2002 by the American Congress of Rehabilitation Medi-
cine and the American Academy of Physical Medicine and
Rehabilitation
From the Department of Pediatrics, University of Minnesota, Minneapolis, MN
(Tervo); Pediatric Section, Gillette Children’s Specialty Healthcare, St. Paul, MN
(Tervo); Department of Pediatrics (Redinius), University of South Dakota (Palmer),
Vermilion, SD; and School of Physical Therapy, The College of Saint Catherine, St.
Paul, MN (Azuma).
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the author(s) or upon any
organization with which the author(s) is/are associated.
Reprint requests to Raymond C. Tervo, MD, MSc, Gillette Children’s Specialty Healthcare,
200 E University Ave, St. Paul, MN 55101, e-mail: rtervo@gillettechildrens.com.
0003-9993/02/8311-6930$35.00/0
doi:10.1053/apmr.2002.34620
N ATTITUDE IS A DISPOSITION or feeling toward a
A person or thing. In medicine, a physician’s attitude to-
1
ward a patient or situation is important because prevailing
attitudes and misconceptions can be potential barriers to suc-
cessful diagnosis and treatment. A physician’s attitude is es-
pecially important when dealing with special populations such
as persons with disability.1-5 A person’s disability may be
viewed as a negative trait by a physician. He/she may also feel
that a person with a disability is different from normal. In either
case, these attitudes or reactions can affect the quality of
medical care for the person with disability. For example, biased
health services staff may allocate resources away from persons
with disability. Negative attitudes of peers may adversely in-
fluence the beliefs of other physicians, compounding the ad-
verse outcomes of the negative attitudes.6
Attitudes toward persons with disability can be influenced by
demographic variables such as age, gender, nationality, martial
status, educational grade level, socioeconomic status, place of
residence (rural vs urban), and experience with disability.7
Negative attitudes toward persons with disability are a product
not only of individual beliefs but also of societal and organi-
zational practices.5,8,9 A previous study10 observed that Amer-
ican college students have more favorable attitudes toward
persons who are blind than French college students. Some
research, performed by using cross-cultural designs, has fo-
cused on differences between 2 or more societies. Greek Amer-
icans have more positive attitudes toward persons with disabil-
ity than Greeks.11 Consistent cultural differences have been
found in measured attitudes toward the disabled. In a 3-country
study,12 respondents in the United States had the most positive
attitudes, followed by respondents from Denmark and Greece.
These observations are important because ethnocentricity may
be associated with negative attitudes toward physically dis-
abled people.13,14
Given that one’s cultural environment influences attitudes, it
is important to consider this effect in medical students. To our
knowledge, there are no international studies comparing med-
ical student attitudes toward persons with disability from 2
different countries.
Our purpose was to investigate different aspects of medical
student attitudes toward persons with disability and factors that
might influence those attitudes. Specifically, we hypothesized
that attitudes toward persons with disability differ between
Canadian and American medical students. Further, we hypoth-
esized that gender and a background in disabilities would
influence these attitudes. Using 3 proposed scales provides a
broader perspective of medical student attitudes than a single
scale. Measuring medical student attitudes may guide educa-
tional interventions and monitor attitudinal change.6,9
METHODS
This study used a cross-sectional survey design of the first-
year medical school classes at the University of South Dakota
(USD) and the University of Saskatchewan (U of S). Ninety
first-year medical students, 46 at USD and 44 at U of S, were
surveyed. All were enrolled at the schools of medicine, USD,
Vermillion, SD, or U of S, Saskatoon, Sask. Surveys were
Arch Phys Med Rehabil Vol 83, November 2002
1538 MEDICAL STUDENTS’ ATTITUDES TOWARD DISABLED PERSONS, Tervo
distributed in both schools before class at the end of the second
term. The surveys supported similar curricula at both medical
schools and explored the relationships among people, medi-
cine, and society.
Both medical schools are located in rural communities and
are of similar size and mission. U of S accepts 55 students and
USD accepts 50 students per academic year. Both schools seek
to provide a quality, broad-based medical education with an
emphasis on family practice. Explicit in their missions is ex-
cellence in education, research, and clinical care. Each has a
regional mandate, often serving people in remote and isolated
communities that have few resources.
Outcome Assessments
The survey consisted of 4 parts: (1) a demographic data
sheet, (2) the Attitude Toward Disabled Persons (ATDP)
Scale,10,15,16 (3) the Scale of Attitudes Toward Disabled
Persons17 (SADP); and (4) the Rehabilitation Situations Inven-
tory18 (RSI). Background in disability was a nominal dichoto-
mous variable (yes, no), and respondents were asked to specify
their backgrounds.
Previous studies of medical students’ attitudes toward per-
sons with disability have used a single measure, usually the
ATDP Scale.4-6,8 The ATDP Scale is probably the best known
and most widely used scale, but concerns have been expressed
that the scale is outdated and may no longer reflect contempo-
rary societal views. In addition, Antonak and Livneh14,15 have
identified misgivings about the psychometric properties of the
scale and contend that attitudes toward persons with disability
are likely nonlinear and multidimensional. Further, Yuker and
Block13 contend that the ATDP Scale should not be used as a
screening device unless it is used as part of a battery of
measures.
To address a lack of research evaluating medical students’
multidimensional attitudes toward disability and concerns
raised by the age of the ATDP Scale, this study presents 3
measurements of attitudes. Each scale we used has a number of
factors or subscales to assess medical students’ attitudes toward
persons with disability from different perspectives. The ATDP
Scale assumes that some people perceive individuals with
disability as being different from and thus inferior to persons
without disability.10,16 The SADP measures attitudes toward
persons with disability as a group. Its 3 subscales— optimism–
human rights, behavioral misconceptions, and pessimism-
hopelessness—are classes of personal action toward persons
with disability.17 The RSI postulates that a working environ-
ment produces challenging situations that can be uncomfort-
able, awkward, or distressing. This scale measures perceptions
of the difficulty of typical rehabilitation situations.18 The sub-
scales highlight particular situations that might be especially
distressing.
Attitude Toward Disabled Persons Scale
The ATDP was developed by Yuker et al.10 The ATDP-
Form O, used in this study, has been shown to be internally
consistent, stable, and reliable, with split– half reliability coef-
ficients ranging from .75 to .85, and test-retest reliability values
of .66 to .89.15 This scale takes about 5 minutes to administer
and consists of 20 items pertaining to persons with disabilities.
The instrument consists of a 6-point Likert scale.
Scale of Attitudes Toward Disabled Persons
The SADP was the second instrument used in this study.
Antonak and Livneh15,17 have described the development and
psychometric analysis of this scale, which contains a 24-item
Arch Phys Med Rehabil Vol 83, November 2002
Likert-type items. Antonak and Livneh15 have reported that the
instrument is reliable, with Spearman-Brown corrected reliabil-
ity coefficients ranging from .81 to .85 and ␣ coefficients
ranging from .88 to .91. Higher scores on this instrument
indicate more positive attitudes toward persons with disabili-
ties. Factor analysis has produced a 3-factor solution identify-
ing 3 subscales: optimism– human rights, behavioral miscon-
ceptions, and pessimism-hopelessness.15 The Spearman-Brown
corrected reliability coefficients for the subscales are .71, .55,
and .61, respectively.17 The ␣ coefficients for each of the
subscales in order are .81, .77, and .82.17
Rehabilitation Situations Inventory
The RSI is the third instrument we used in this study. Dunn
et al18 reported that the inventory is a highly reliable instru-
ment, with a Pearson correlation of .88 between odd items and
even items and an internal consistency as assessed by coeffi-
cient ␣ of .93. The instrument was developed to assess respon-
dents’ perceptions of difficult rehabilitation situations. The RSI
contains 30 Likert-type items, which are scored on a scale of 1
to 5. Higher scores on this instrument indicate that respondents
may have more difficulty with difficult rehabilitation situations.
A total score is obtained by calculating the mean over all 30
items, with higher scores indicating more discomfort. Factor
analysis of the inventory produced 6 subscales: aggression,
sexual situations, staff/staff, families, depression, and motiva-
tion/adherence.18 The 1-week test-retest reliability for each of
the 6 subscales found correlations that ranged from .730 to .870
with a mean of .807, and the ␣ coefficients that ranged from .72
to .84.15,17
Sample items with the highest loading from each of the
subscales are presented to show what was surveyed. Aggres-
sion contains 6 items. Two items are “Patient who is vulgar,
abusive, and offensive to you” and “Talking to a patient who is
overly aggressive.” The second scale, sexual situations, has 4
items. Two items are “Patient makes a sexual advance during
treatment” and “During a transfer a patient repeatedly kisses
you on the neck.” Staff/staff has 4 items. Two of the items with
the highest loading are “Doctor comes in during treatment and
ignores staff member and patient, and begins procedure” and
“Being put down by another staff member in front of a patient.”
Families has 5 items, 2 of which are “Spouse says, ‘Will he
walk out of here?’” and “Family says, ‘When is he going to
walk out of here?’.” Depression has 3 items. Two items are
“Patient says, ‘I just feel like giving up’” and “Patient says,
‘I’m only twenty years old. How can I handle this?’.” The last
scale, motivation/adherence, has 7 items, 2 items of which are
“Patient ‘forgets’ to come to treatment repeatedly” and “Patient
refuses to use splint even though it prevents damage.”18
Data Analysis
All statistics were calculated with SPSS, version 10.1a for
Windows. Missing items were handled as outlined by Yuker et
al.10 If more than 10% of the items were left blank (eg, 3 items
on the 20-item scale, 4 on the 30-item scale), the test was
considered not scorable. If 10% or fewer of the items were
omitted, the completed items were scored as usual, with the
customary constant added according to scoring instruc-
tions.10,17,19 All tests had 10% or fewer items omitted, so all
tests were scored. Descriptive statistics were calculated to
describe the groups within the sample. The internal consistency
of the items used to form the ATDP, SADP, and RSI scales was
assessed by calculating the Cronbach ␣. For comparing groups,
an ␣ of 0.7 to 0.8 was regarded as satisfactory. Independent t
tests were used to compare the demographic data and ATDP,
SADP, and RSI scores between cohorts. One-sample t tests
 MEDICAL STUDENTS’ ATTITUDES TOWARD DISABLED PERSONS, Tervo 1539

were used to compare attitude scores with scale norms. Scale year medical students’ attitudes were comparable to the norms
norms for the ATDP were derived from a sample of 625 on the total score. First-year medical students were less com-
Hofstra University students.10 SADP norms were calculated fortable with sexual situations and depression, and more com-
from a sample of 225 undergraduate and graduate students at fortable with motivation/adherence compared with scale
the University of New Hampshire.17 The sample for the RSI norms. There were no differences between the medical student
norms was a cohort of 177 staff members working in 3 reha- cohort and scale norms on aggression, staff/staff, and families
bilitation facilities in 3 US states.19 Analyses of variance (table 3).
(ANOVAs) were done to compare mean attitude scale scores
and the interaction of gender and experience. Two-tailed P Background in Disability and Gender
values of less than .05 were considered to indicate statistical There were differences in attitudes toward persons with
significance. disability of first-year medical students by gender (table 4). On
the ATDP scale, male medical students held poorer attitudes
RESULTS than female medical students. Male students had more behav-
ioral misconceptions and they stated that they were less com-
Reliability fortable dealing with a patient who was depressed.
The internal consistency of the items, the Cronbach ␣, which Two-factor ANOVAs were used to test the individual and
was used during initial creation of the ATDP, SADP, and RSI interaction between gender and background in disability. Over-
scales, was calculated (ATDP, ␣⫽.8550; SADP, ␣⫽.8190; all (full-scale) scores and individual scale scores for the ATDP,
RSI, ␣⫽.8827). The full scales were satisfactory for comparing SADP, and the RSI were analyzed. In all 3 cases, interactions
the study groups because each had a Cronbach ␣ greater than were nonsignificant: ATDP (F1⫽.004, P⫽.497), SADP
0.7. (F1⫽.140, P⫽.710), and RSI (F1⫽.151, P⫽.699). Gender was
significant for the full ATDP Scale, with women having more
Demographic Variables positive attitudes than men (F1⫽3.86, P⫽.05). Background in
Of the 90 first-year medical students, 53 were men and 37 disability was significant for the full RSI scale (F1⫽4.18,
women. The response rate from USD was 92% and from U of P⫽.044).
S, 80%. The mean age ⫾ standard deviation (SD) was Three subscales on the SADP and 6 subscales of the RSI
24.25⫾3.97 years. Saskatchewan students were younger, with were also analyzed. Again, the 2-factor ANOVA revealed no
a mean age 23.00⫾3.16 years versus 25.48⫾4.33 years significant interactions for each of the subscales. Significant
(t85⫽3.04, P⫽.003), and were from larger home communities (␹25
⫽24.35, P⫽.000). There were no differences between cohorts
Table 1: Demographic Characteristics of Medical Students
in marital status (73.3% single), mean number of children
(mean, .17⫾.50), ethnicity (80% white), size of home commu- Location of Survey
nity (31.1% from communities ⬍5000 people), background in USD U of S
disability (20%), or years of experience in disability (mean,
2.46⫾1.90) (table 1). Backgrounds included a relative with a (n⫽46) (n⫽44)
disability (eg, sibling), volunteer work or employment (eg, Gender
Special Olympics), and an undergraduate course in disability or Male 27 26
rehabilitation. Female 19 18
Mean age ⫾ SD (y) 25.48⫾4.33 23.00⫾3.16
Medical School Comparisons Marital status
Single, never married 29 37
The medical student mean ATDP score was 76.72⫾11.60,
Married 14 7
their mean SAPD score was 116.30⫾14.16, and their mean
Divorced 2 0
RSI score was 2.92⫾0.51. There were no differences between
Other 1 0
the medical student groups from the United States and Canada
Mean no. of children ⫾ SD .26⫾.61 .07⫾.33
on the ATDP, SAPD, and RSI scores or the SAPD and RSI
Size of home community
subscale scores (table 2). Because the groups did not differ
⬍5000 17 11
significantly, all subsequent analyses were performed on the
5,000–10,000 5 4
combined medical student sample.
10,001–25,000 7 0
25,001–50,000 4 2
Comparison With Norm Values
50,001–100,000 5 0
First-year medical students were compared with normative 100,001 8 27
values for each of the full scales and subscales. On the ATDP Ethnicity/race
Scale, medical students’ attitudes toward persons with disabil- White 43 29
ity were the same as college students’ attitudes.10 The former’s American Indian/Alaskan Native 1 1
attitudes toward persons with disability were less positive than Asian/Pacific Islander 1 7
able-bodied persons10 (table 3). Other 1 7
The SADP has 3 subscales: optimism– human rights, behav- Do you have a disabled relative?
ioral misconceptions, and pessimism-hopelessness. Medical Yes 10 7
students’ attitudes were less positive than the norms on the total No 36 37
score and on the optimism– human rights subscale. There were Background in disability?
no differences between the combined medical student cohort Yes 9 9
and behavioral misconceptions and pessimism-hopelessness17 No 37 35
(table 3). Mean years of experience in
The RSI has 6 subscales: aggression, sexual situations, staff/ disability ⫾ SD 2.33⫾1.21 2.57⫾2.44
staff, families, depression, and motivation/adherence. First-

Arch Phys Med Rehabil Vol 83, November 2002

1540 MEDICAL STUDENTS’ ATTITUDES TOWARD DISABLED PERSONS, Tervo

Table 2: Attitudes of First-Year Medical Students Toward Persons Table 4: Comparison of the Attitudes of First-Year Medical
With Disability by Location Students by Gender Toward Persons With Disability

USD U of S Gender
Mean ⫾ SD Mean ⫾ SD
Male Female
ATDP Scale 77.77⫾8.54 75.54⫾14.31 Mean ⫾ SD Mean ⫾ SD
SADP 114.05⫾15.21 119.13⫾12.39 ATDP Scale 73.95⫾12.06* 80.75⫾9.71
Optimism–human rights 51.10⫾6.77 52.28⫾7.09 SADP 114.29⫾14.46 119.32⫾13.39
Behavioral misconceptions 34.10⫾4.61 35.35⫾3.98 Optimism–human rights 51.61⫾6.61 51.83⫾7.43
Pessimism-hopelessness 31.64⫾3.62 30.93⫾4.03 Behavioral misconceptions 33.67⫾4.31† 36.07⫾4.11
RSI 2.91⫾.49 2.93⫾.54 Pessimism-hopelessness 31.04⫾3.88 31.59⫾3.79
Aggression 2.89⫾.62 2.88⫾.65 RSI 2.90⫾.43 2.95⫾.61
Sexual situations 3.16⫾.84 3.14⫾.91 Aggression 2.79⫾.66 3.02⫾.59
Staff/staff 3.14⫾.71 3.12⫾.62 Sexual situations 3.05⫾.80 3.29⫾.96
Families 2.87⫾.74 2.94⫾.79 Staff/staff 3.12⫾.68 3.16⫾.64
Depression 3.04⫾.95 3.11⫾.87 Families 2.95⫾.67 2.85⫾.89
Motivation/adherence 2.64⫾.60 2.85⫾.75 Depression 3.26⫾.82‡ 2.83⫾.99
Motivation/adherence 2.77⫾.63 2.71⫾.76

NOTE. A high score on the ADTP and SADP indicates more positive
attitudes. A high score on the RSI indicates more discomfort. Un-
gender effects were noted on the SADP behavioral misconcep- paired t test. Two-tailed P value.
tions subscale (F1⫽6.95, P⫽.010). Gender did not influence * P⫽.011.
perceptions of optimism– human rights (F1⫽.425, P⫽.517) or †
‡
P⫽.021.
pessimism-hopelessness (F1⫽.173, P⫽.679). Female medical P⫽.026.
students had fewer behavioral misconceptions about persons
with disability. No other significant gender effects were found.
Background effects were noted on the families (F1⫽3.89, attitudes to persons with disability the more likely they were to
P⫽.010) and depression (F1⫽4.19, P⫽.021) subscales of the be comfortable with challenging rehabilitation situations
RSI. Background in disability did not influence perceptions of (r⫽⫺.435, P⫽.000).
aggression (F1⫽2.012, P⫽.160), sexual situations (F1⫽.182,
P⫽.671), staff/staff (F1⫽.025, P⫽.875), or motivation/adher- DISCUSSION
ence (F1⫽1.941, P⫽.167). Those first-year medical students One goal of our study was to determine whether the attitudes
with a background in disability were more comfortable with toward persons with disability of medical students from similar
family rehabilitation issues and patients with depression. Com- geographic areas but dissimilar health care systems (Canada,
fort with challenging rehabilitation situations showed signifi- United States) differed. The 2 first-year medical student co-
cant differences across levels of experience but not gender horts surveyed are important examples because both were
(F1⫽960.75, P⫽.04). The more positive medical students’ enrolled in medical schools that train primary care practitioners
as an explicit mission and a larger percentage of these students
will become family physicians. General practitioners are
Table 3: Comparison of Attitude Scores on 3 Scales With Norm thought to have more contact with persons with disabilities
Values than any other professions or agencies.
Test Value Saskatchewan lies directly north of the wheat belt of South
Mean ⫾ SD (norm) P Dakota, and the USD and U of S medical schools are both
centered in sparsely populated rural constituencies in which
ATDP Scale* 76.72⫾11.60 75.11 .24
agriculture is a predominant industry. With a common border
SADP† 116.30⫾14.16 121.51 .000
and a common culture, Canadians and Americans have closer
Optimism–human rights 51.70⫾6.92 55.30 .000
economic links than any other pair of independent nations in
Behavior misconceptions 34.64⫾4.36 34.78 .785
the world. However, when it comes to health care systems,
Pessimism-hopelessness 31.28⫾3.83 31.42 .741
there are vast differences, which mirror the American convic-
RSI‡ 2.92⫾0.51 3.00 .165
tion in limited government and individualism and the Canadian
Aggression 2.88⫾0.63 2.99 .117
values of communal obligation and big government.20
Sexual situations 3.15⫾0.87 2.77 .000
In contrast to the United States, Canada’s health care system
Staff/staff 3.13⫾0.66 3.22 .190
historically has relied extensively on primary care physicians.
Families 2.90⫾0.76 2.77 .108
They are usually the patient’s initial contact with the formal
Depression 3.08⫾0.91 2.69 .000
health system and they control access to most specialists, many
Motivation/adherence 2.75⫾0.86 2.81 .000
allied providers, hospital admissions, diagnostic testing, and
* The higher the score, the more positive the attitudes. For college prescription drug therapy. When Canadians need medical care,
students without disability, higher scores represent a more accept- they go to the physician or clinic of their choice and present the
ing attitude.9 health insurance card issued to all eligible residents of a prov-
†
The higher the score, the more positive the attitudes. The norms
are derived from a sample of college students at the University of
ince. Canadians do not pay directly for insured hospital and
New Hampshire.16 physicians’ services, nor are they required to fill out forms for
‡
The items are rated on a scale of 1 to 5, with 5 being the most insured services. There are no deductibles, copayments, or
difficult. Total score for the scale and each subscale is obtained by dollar limits for insured services. Health care in Canada is
calculating the mean over the relevant items with a higher score
indicating more discomfort. The test values (norms) are those of
financed primarily through taxation. Canada’s health care sys-
staff members in 2 Veterans Administration spinal cord injury cen- tem operates on implicit rationing; most rationing choices are
ters and 1 general outpatient rehabilitation facility.17 made within the patient– health care provider relationship in

Arch Phys Med Rehabil Vol 83, November 2002

 MEDICAL STUDENTS’ ATTITUDES TOWARD DISABLED PERSONS, Tervo
which the decisions of primary care health providers determine
the allocation of health care resources. In the United States,
there is an explicit system of rationing where funds for personal
health care are initially extracted from households as payroll
deductions, taxes, and direct payments and the standards of
health care are more directly influenced by the allocation
decisions in that household.21
Rural communities in Saskatchewan have always had trou-
ble getting and keeping good doctors at the price the province
can afford to pay. Provincial medical services have been spread
over a thinly populated area, where extensive areas become
inaccessible during fierce winters. Because most of the prov-
ince consists of vast rural stretches, it has been difficult to
secure adequate medical service for most of Saskatchewan. A
similar though less extreme situation exists in South Dakota,
where the most medically ill served groups are Native Amer-
icans living on impoverished reservation communities.
To address the problem of delivering health care services for
persons with disability, laws have been enacted in both coun-
tries to ensure accessibility—in the United States, the Ameri-
cans with Disabilities Act, and in Canada, rights to access
health care services are covered under the provincial Human
Rights Codes and the Canada Health Act.3 Principles of the
Canada Health Act—including public administration, univer-
sality, portability, accessibility, and, most problematically,
comprehensiveness— differentiate how health care is funded
and delivered in Canada as compared with the United States.
Comprehensiveness embraces “all insured (medically neces-
sary) health services.”3
Most students entering medical school in Saskatchewan are
aware of the province’s legislative history of ensuring hospital
and medical services22 and the overt differences in health care
delivery between Canada and the United States.
In contrast to the recent health reform efforts in the United
States, initiatives for a national health insurance plan for hos-
pital and medical care in Canada are based on a political
ideology that emphasizes social reforms.23
Despite the sociocultural differences, there were no differ-
ences between cohorts in their measured attitudes to disabled
persons. It is possible that the similarity of both rural locations
may have influenced the results. In addition, it is possible that
the scales were not sensitive enough to these issues in the
cohort selected. However, it may be that sociocultural factors
were diminished by the overriding culture of medical school. It
is possible that the professional culture of medical schools in
Canada and the United States and the medical student selection
process has a greater influence on the attitudes of first-year
medical students than other sociocultural variables.
The medical students cohorts had ATDP Scale scores com-
parable to the norms among able-bodied students. Medical
students have poorer attitudes toward persons with disability
than the norms observed on the SADP. They tended to view
issues less positively on the optimism– human rights subscale.
The items on this subscale express positive and optimistic
views about persons with disability and affirm their human
rights, such as the opportunity to live in adequate housing in a
place of their choosing, and to work in the mainstream.15
Among physicians, disability is seen as synonymous with in-
ability and is seen as incompatible with the highly competent
physician-healer.24
Advancing the rights of people with disability early in med-
ical school curricula may avoid unnecessary negative atti-
tudes.1 This is especially important if physicians and other
professionals are charged with working with communities to
change the attitudes, beliefs, and behaviors of policymakers
and the public.1
1541
Our analysis found no significant interactions between gen-
der and background in disability. Individual effects of gender
and background were found among the different scales. Female
medical students had more positive attitudes toward persons
with a disability than did male medical students. Female med-
ical students were more accepting and less likely to hold
prejudicial attitudes toward persons with a disability. There
were gender differences in attitudes toward persons with a
disability and, in deference to this observation, Yuker et
al10,13,16 report male and female norms for the ATDP Scale.
Female medical students had fewer behavioral misconceptions.
They were less likely to view rehabilitation programs as too
expensive and less likely to see children with a disability
having an adverse affect on others in regular classrooms. Male
medical students were at greater risk of holding negative atti-
tudes toward persons with disability, and specific educational
experiences need to be created to change these attitudes posi-
tively. Educational interventions may capitalize on this differ-
ence by encouraging female medical students to be leaders in
those portions of medical school curriculum that deal with
persons with disability.
The more positive a medical student’s attitudes toward per-
sons with disability, the more likely he/she will be comfortable
with challenging rehabilitation situations. The task is to design
educational interventions that will foster the development of
positive attitudes toward persons with a disability. Interven-
tions may include creating pleasant and rewarding contact with
persons with disability, creating familiar rather than casual
contact with the person with disability, and having a setting
that involves important activities or activities from which sub-
ordinate educational goals emerge. Interventions may include
having parents of children with a disability share personal
experiences, having the opportunity to act as teachers of indi-
viduals with disability, or having individuals with a disability
as teachers. Equal-status contact is required for positive atti-
tude formation.25 It is important that medical students have role
models who demonstrate positive attitudes toward persons with
disability. These role models may be their clinical mentors or
other community members with whom they interact outside
their clinical training.8,25 Active learning using role-playing
may be a constructive approach.
The measures discussed may be useful instruments with
which to assess the impact of educational interventions in a
medical school curriculum on student attitudes toward persons
with disability.2 As repeated measures, it would be interesting
to follow medical students’ attitudes toward persons with dis-
ability as they enter medical school and progress from the basic
to the clinical sciences. As medical students begin to under-
stand the vocational relevance of caring for a person with a
disability, it has been hypothesized that deep learning will
result in a positive change in attitudes.26,27
CONCLUSION
First-year medical students in 2 different rural settings held
similar attitudes toward persons with disability regardless of
medical school location and had less positive attitudes on
different dimensions of attitudes toward disability. First-year
male medical students in the rural medical schools surveyed
were at greater risk of holding negative attitudes. Those with a
background in disability were more comfortable with challeng-
ing rehabilitation situations. The more positive their attitudes,
the greater their comfort. Specific educational experiences in
medical school are needed to promote more positive physician
attitudes to persons with disabilities.
Arch Phys Med Rehabil Vol 83, November 2002
1542 MEDICAL STUDENTS’ ATTITUDES TOWARD DISABLED PERSONS, Tervo
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