The attitudes of medical students towards homeless people: does medical school make a difference?


Helen Lester MB, BCH, FRCGP, MA, MD, Department of Primary Care, Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Tel.: 00 44 121 414 2684; Fax: 00 44 121 414 6572; E-mail:


Background  Homeless people have greater health care needs than those who are housed, yet often experience difficulty in accessing health care. Evidence suggests that the attitudes of doctors can create significant barriers to health care for homeless people.

Methods  A validated structured questionnaire, the Attitudes Towards the Homeless Questionnaire (ATHQ), was posted to a year group of 211 medical students 2 weeks prior to their starting at the University of Birmingham in 1997, and again during their final clinical placement 5 years later. The results were explored in more depth through semistructured interviews with the 12 students displaying the greatest degree of attitude change.

Results  The response rates for the 1997 and 2002 surveys were 80% and 82%, respectively, with an overall response rate of 65% of eligible students. The mean ATHQ scores for the 2 time periods were 76·3 and 74·7 (mean difference = 1·66 ± 0·8, paired t test = 2·07, P = 0·04), indicating that attitudes had become more negative during the 5-year period. Semistructured interviews highlighted the importance of professional socialisation and clinical contact on attitude development.

Conclusion  This study suggests that medical students may hold more negative attitudes towards homeless people at the end of their undergraduate course than they do at the beginning of it. Medical schools may need to address this area of health care more directly in the undergraduate curriculum if tomorrow's doctors are to treat all patients equally.