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Patient-centred care is an important aspect of quality health care. The learning environment may impact medical students’ adoption of patient-centred behaviours.
All medical students at a single institution received an anonymous, modified version of the Communication, Curriculum, and Culture instrument that measures patient-centredness in the training environment along three domains: role modelling, students’ experience, and support for patient-centred behaviours. We compared domain scores and individual items by class year and gender, and qualitatively analyzed responses to two additional items that asked students to describe experiences that demonstrated varying degrees of patient-centredness.
Year 1 and 2 students reported greater patient-centredness than year 3 and 4 students in each domain: role modelling (p = 0.03), students’ experience (p = <0.001), and support for patient-centred behaviours (p < 0.001). Female students reported less support for patient-centred behaviours compared with male students (p = 0.03). Qualitative analysis revealed that explicit patient-centred curricula and positive role modelling fostered patient-centredness. Themes relating to low degrees of patient-centredness included negative role modelling and students being discouraged from being patient-centred.
Students’ perceptions of the patient-centredness of the learning environment decreased as students progressed through medical school, despite increasing exposure to patients. Qualitative analysis found that explicit patient-centred curricula cultivated patient-centred attitudes. Role modelling impacted student perceptions of patient-centredness within the learning environment.
Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-centered medicine: transforming the clinical method, 3rd ed. Oxford: Radcliffe Publishing; 2014.
Aita V, McIlvain H, Backer E, McVea K, Crabtree B. Patient-centered care and communication in primary care practice: what is involved? Patient Educ Couns. 2005;58:296–304. CrossRef
Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington D.C.: National Academies Press; 2001.
Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7. CrossRef
Haidet P, Kelly PA, Chou C. Communication, Curriculum, and Culture Study Group. Characterizing the patient-centeredness of hidden curricula in medical schools: development and validation of a new measure. Acad Med. 2005;80:44–50. CrossRef
Crabtree BF, Miller WL. Doing Qualitative Research. Newbury Park: SAGE; 1999, pp 21–3.
Bombeke K, Symons L, Debaene L, De Winter B, Schol S, Van Royen P. Help, I’m losing patient-centredness! Experiences of medical students and their teachers. Med Educ. 2010;44:662–73. CrossRef
Bombeke K, Symons L, Vermeire E, et al. Patient-centredness from education to practice: the ‘lived’ impact of communication skills training. Med Teach. 2012;34:e338–48. CrossRef
Record JD, Rand C, Christmas C, et al. Reducing Heart Failure Readmissions by Teaching Patient-Centered Care to Internal Medicine Residents. Arch Intern Med. 2011;171:858–9. CrossRef
Gray GR. Teaching patient-centered care. Fam Med. 2002;34:644–5.
Haidet P, Stein HF. The role of the student-teacher relationship in the formation of physicians. The hidden curriculum as process. J Gen Intern Med. 2006;21(Suppl 1):16–20. CrossRef
Shochet RB. Learning communities: a new twist to medical education. Md Med. 2012;13:13–4.
Thiedke C, Blue AV, Chessman AW, Keller AH, Mallin R. Student observations and ratings of preceptor’s interactions with patients: the hidden curriculum. Teach Learn Med. 2004;16:312–6. CrossRef
Haidet P, Kelly PA, Bentley S, et al. Not the Same Everywhere. J Gen Intern Med. 2006;21:405–9. CrossRef
Diseker RA, Michielutte R. An analysis of empathy in medical students before and following clinical experience. Acad Med. 1981;56:1004. CrossRef
Griffith CH, Wilson JF. The Loss of Idealism Throughout Internship. Eval Health Prof. 2003;26:415–26. CrossRef
Griffith CH III, Wilson JF. The Loss of Student Idealism in the 3rd-Year Clinical Clerkships. Eval Health Prof. 2001;24:61–71. CrossRef
Haidet P, Dains JE, Paterniti DA, et al. Medical student attitudes toward the doctor-patient relationship. Med Educ. 2002;36:568–74. CrossRef
Rezler AG. Attitude changes during medical school: a review of the literature. Acad Med. 1974;49:1023. CrossRef
Hardeman RR, Burgess D, Phelan S, Yeazel M, Nelson D, van Ryn M. Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. Patient Educ Couns. 2015;98:350–5. CrossRef
- Medical students’ perceptions of the patient-centredness of the learning environment
Mark V. Wilcox
Megan S. Orlando
Cynthia S. Rand
Roy C. Ziegelstein
Laura A. Hanyok
- Bohn Stafleu van Loghum