The 2006 Annual Social and Economic Supplement to the Current Population Survey reported that 47 million people (8.7 million children) were without health insurance. (1) The statistics for uninsured non-Hispanic whites did not change significantly from 2005. However, the rates and numbers for uninsured African Americans and Hispanics increased. Minority populations, especially those with lower socioeconomic status, have poorer health outcomes. (2-4) Academic health centers, although economically stressed, have a social contract to train competent professionals, improve health care access and quality, and grow their research enterprises prudently. (5) Nurturing a commitment to service as part of medical professionalism is essential if we hope to address the health of those who have been marginalized in our health care system. Thus, educators must consider how service-learning experiences within the formal curricula can promote "responsible professionalism and personal sacrifice" fundamental to the practice of medicine. (6,7)
Because health care professionals frequently interact with uninsured or indigent patients, it is important to uncover explicit attitudes towards vulnerable groups before learners begin their professional careers and to determine when educational experiences should be implemented to influence positive change. (7) Attention must be paid to the students' intention to perform services for these vulnerable patients and how these intentions are influenced by underlying attitudes. The theory of planned behavior, which is well supported by empirical evidence, espouses that "intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control... " (8) However, the relationship between attitudes and clinical decision-making has not been well studied.
Pharmacy students' attitudes have been assessed concerning the elderly, (9) mental illness, (10) human immunodeficiency virus (HIV), (11) pharmaceutical care, (12) and changes resulting from the educational process itself (13-15) Twenty-five years ago, third-, fourth- and fifth-year pharmacy students' attitudes were assessed on various social factors: determinants of patients' health and illness, interpersonal relationships between health professional and patient, government's involvement in health care costs, and views on social problems outside of Medicine. (16) Each subsequent year, students' attitudes declined in concern for patients as individuals and increased in cynicism and anxiety. Although the study was cross-sectional, it illustrated that students' attitudes were less favorable in succeeding years.
Medical students' attitudes differ from entry to graduation, (17) with considerable declines in idealism and tolerance after the first 2 years. (7,18) Historically, interpretations of these findings have differed, although most educators would agree that medical school "constitutes a strong socializing experience. (19-23)
Several studies have assessed medical students' attitudes about the elderly, (24,25) patients with HIV, (26,27) educational process changes, (28-31) comprehensive medical care effects, (32) and expectations of values and behaviors. (33) There have been investigations by international colleagues concerning medical students' attitudes about social issues in medicine. (34-39) Outcomes of these studies imply that attitudes toward social issues are global.
Although there is considerable interest in the health professions concerning lack of available care to underserved populations, there has been no longitudinal comparison of health professionals' attitudes toward this group. Because attitudes may predict behavior (intention to provide care), the objective of this study was to longitudinally assess pharmacy and medical students' attitudes toward the underserved. The primary research questions were: What are the attitudes of pharmacy and medical students toward the underserved? …