Abstract
BACKGROUND: Learning environments overtly or implicitly address patient-centered values and have been the focus of research for more than 40 years, often in studies about the “hidden curriculum.” However, many of these studies occurred at single medical schools and used time-intensive ethnographic methods. This field of inquiry lacks survey methods and information about how learning environments differ across medical schools.
OBJECTIVE: To examine patient-centered characteristics of learning environments at 9 U.S. medical schools.
DESIGN: Cross-sectional internet-based survey.
PARTICIPANTS: Eight-hundred and twenty-three third- and fourth-year medical students in the classes of 2002 and 2003.
MEASUREMENTS: We measured the patient-centeredness of learning environments with the Communication, Curriculum, and Culture (C3) Instrument, a 29-item validated measure that characterizes the degree to which a medical school’s environment fosters patient-centered care. The C3 Instrument contains 3 content areas (role modeling, students’ experiences, and support for students’ patient-centered behaviors), and is designed to measure these areas independent of respondents’ attitudes about patient-centered care. We also collected demographic and attitudinal information from respondents.
RESULTS: The variability of C3 scores across schools in each of the 3 content areas of the instrument was striking and statistically significant (P values ranged from .001 to .004). In addition, the patterns of scores on the 3 content areas differed from school to school.
CONCLUSIONS: The 9 schools demonstrated unique and different learning environments both in terms of magnitude and patterns of characteristics. Further multiinstitutional study of hidden curricula is needed to further establish the degree of variability that exists, and to assist educators in making informed choices about how to intervene at their own schools.
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Supported by grants from the Bayer Institute for Health Care Communication and the Baylor College of Medicine Academy of Distinguished Educators Fullbright and Jaworski Fund for Medical Education Research. At the time of this writing, Drs. Haidet, Kelly, and Helmer were supported by career development awards from the Office of Research and Development, Health Services R&D Service, U.S. Department of Veterans Affairs. A mentoring relationship between Drs. Inui (mentor) and Haidet (mentee) is supported by a research mentorship award from the Society of General Internal Medicine. In addition to the authors, the Communication, Curriculum, and Culture Study Group includes Vinay Babu, MD, Mark Kuebeler, MS, Gregory Makoul, PhD, Linda Perkowski, PhD, Boyd Richards, PhD, A. Lynn Snow, PhD, and Julianne Souchek, PhD. The opinions contained herein are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs, The Bayer Institute for Health Care Communication, or the institutions of the C3 Study Group Investigators.
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Haidet, P., Kelly, P.A., Bentley, S. et al. Not the same everywhere. J GEN INTERN MED 21, 405–409 (2006). https://doi.org/10.1111/j.1525-1497.2006.00417.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00417.x