Characteristics of first-year students in Canadian medical schools

BACKGROUND: The demographic and socioeconomic profile of medical school classes has implications for where people choose to practise and whether they choose to treat certain disadvantaged groups. We aimed to describe the demographic and socioeconomic characteristics of first-year Canadian medical students and compare them with those of the Canadian population to determine whether there are groups that are over- or underrepresented. Furthermore, we wished to test the hypothesis that medical students often come from privileged socioeconomic backgrounds. METHODS: As part of a larger Internet survey of all students at Canadian medical schools outside Quebec, conducted in January and February 2001, first-year students were asked to give their age, sex, self-described ethnic background using Statistics Canada census descriptions and educational background. Postal code at the time of high school graduation served as a proxy for socioeconomic status. Respondents were also asked for estimates of parental income and education. Responses were compared when possible with Canadian age-group-matched data from the 1996 census. RESULTS: Responses were obtained from 981 (80.2%) of 1223 first-year medical students. There were similar numbers of male and female students (51.1% female), with 65% aged 20 to 24 years. Although there were more people from visible minorities in medical school than in the Canadian population (32.4% v. 20.0%) (p < 0.001), certain minority groups (black and Aboriginal) were underrepresented, and others (Chinese, South Asian) were overrepresented. Medical students were less likely than the Canadian population to come from rural areas (10.8% v. 22.4%) (p < 0.001) and were more likely to have higher socioeconomic status, as measured by parents' education (39.0% of fathers and 19.4% of mothers had a master's or doctoral degree, as compared with 6.6% and 3.0% respectively of the Canadian population aged 45 to 64), parents' occupation (69.3% of fathers and 48.7% of mothers were professionals or high-level managers, as compared with 12.0% of Canadians) and household income (15.4% of parents had annual household incomes less than $40 000, as compared with 39.7% of Canadian households; 17.0% of parents had household incomes greater than $160 000, as compared with 2.7% of Canadian households with an income greater than $150 000). Almost half (43.5%) of the medical students came from neighbourhoods with median family incomes in the top quintile (p < 0.001). A total of 57.7% of the respondents had completed 4 years or less of postsecondary studies before medical school, and 29.3% had completed 6 or more years. The parents of the medical students tended to have occupations with higher social standing than did working adult Canadians; a total of 15.6% of the respondents had a physician parent. INTERPRETATION: Canadian medical students differ significantly from the general population, particularly with regard to ethnic background and socioeconomic status.

研究背景：医学院学生群体的人口统计学与社会经济特征，对其毕业后的执业地点选择，以及是否愿意为特定弱势人群提供诊疗服务均具有重要意义。本研究旨在描述加拿大一年级医学生的人口统计学与社会经济特征，并与加拿大普通人群进行对比，以明确是否存在占比过高或过低的群体；同时验证「医学生往往来自社会经济地位较高的特权阶层」这一假说。
研究方法：本研究作为2001年1月至2月开展的一项针对魁北克省外所有加拿大医学院校在校学生的大型互联网调查的子项目。调查要求一年级医学生报告年龄、性别、采用加拿大统计局（Statistics Canada）人口普查分类标准的自我报告族裔背景，以及教育背景。以受访者高中毕业时的邮政编码作为其社会经济地位的替代评估指标，同时要求受访者估算父母的收入与受教育程度。研究尽可能将回收的有效数据与1996年加拿大人口普查中按年龄组匹配的普通人群数据进行对比分析。
研究结果：本次调查共纳入1223名一年级医学生，回收有效问卷981份，有效回收率为80.2%。男女学生人数基本均衡，女性占比为51.1%；65%的学生年龄处于20~24岁区间。尽管医学院校中可见少数族裔学生的总占比（32.4%）高于加拿大普通人群（20.0%，p<0.001），但部分少数族裔群体（黑人与原住民）的占比仍低于普通人群，而另一些群体（华裔、南亚裔）的占比则高于普通人群。医学生来自农村地区的比例显著低于加拿大普通人群（10.8% vs 22.4%，p<0.001），且整体社会经济地位更高。具体而言：在父母受教育程度方面，39.0%的父亲与19.4%的母亲拥有硕士或博士学位，而45~64岁的加拿大普通人群中对应比例分别为6.6%与3.0%；在父母职业方面，69.3%的父亲与48.7%的母亲为专业技术人员或高层管理人员，而加拿大普通在职人群中该比例仅为12.0%；在家庭收入方面，15.4%的受访者父母家庭年收入低于4万加元，而加拿大普通家庭的对应比例为39.7%；17.0%的受访者父母家庭年收入超过16万加元，而加拿大普通家庭年收入超过15万加元的比例仅为2.7%。近半数（43.5%）的医学生来自家庭收入中位数处于全国最高五分位区间的社区（p<0.001）。总计57.7%的受访者在进入医学院前完成了不超过4年的中学后高等教育，29.3%的受访者完成了6年及以上的高等教育。医学生父母的职业社会地位整体高于加拿大在职成年人群；另有15.6%的受访者父母一方为执业医师。
研究解读：加拿大一年级医学生与普通人群存在显著差异，尤其是在族裔背景与社会经济地位两个维度。