Does clinical training period support patient-centeredness perceptions of medical students?

Figures & data

Table 1. Comparison of study group with students lost to follow-up.

	Lost n = 69	Study group n = 144	p*	Effect Size
Gender
Male	34	69	0.484^&	0.012
Female	35	75
PCQ scores
Role modeling	30.2 ± 3.4	30.5 ± 2.5	0.180	−0.09
Students’ experiences	44.1 ± 4.7	44.5 ± 5.6	0.417	−0.05
Patients as objects	20.3 ± 3.6	20.5 ± 2.5	0.710	−0.01
Learning relationships	16.2 ± 2.4	16.2 ± 2.1	0.920	−0.01
Bad news for patients and students	7.8 ± 1.0	7.9 ± 1.1	0.090	−0.09
Support for patient-centered behaviors	11.7 ± 1.4	11.8 ± 1.6	0.627	−0.02
Overall	86.9 ± 7.7	86.8 ± 9.7	0.643	−0.07

*Mann–Whitney U test.

^&Chi-square test.

Table 2. Content area and dimension scores of the C3 instrument in clinical training years of medical education.

Content area/Dimension of C3	Student scores (mean ± SD)			p*	Effect size^β
	Fourth year	Fifth year	Sixth year
Role modeling	70.5 ± 18.1	66.3 ± 16.7	62.6 ± 14.6	<0.001	0.27
Students’ experiences	33.8 ± 5.5	33.0 ± 5.2	30.8 ± 4.9	<0.001	0.22
Patients as objects	13.6 ± 4.4	12.9 ± 4.2	12.0 ± 3.2	0.012	0.12
Learning relationships	12.6 ± 3.1	12.7 ± 2.6	12.0 ± 2.5	0.264	0.10
Bad news for patients and students	7.6 ± 1.4	7.4 ± 1.4	6.8 ± 1.5	0.001	0.25
Support for patient-centered behaviors	9.9 ± 2.9	10.6 ± 2.8	10.3 ± 2.6	0.080	0.13
Overall	114.2 ± 17.4	109.9 ± 17.5	103.9 ± 17.0	<0.001	0.42

*Friedman test.

^βKendall’s coefficient of concordance.

Table 3. Comparison of initial and final PCQ scores representing ideal patient-centeredness perceptions of the students.

Content area/Dimension of PCQ	Student scores (mean ± SD)
	Initial PCQ	Final PCQ	p*	Effect size
Role modeling	30.5 ± 2.5	24.3 ± 1.1	<0.001	−0.606
Students’ experiences	44.5 ± 5.6	39.4 ± 3.6	<0.001	−0.593
Patients as objects	20.5 ± 2.5	18.0 ± 2.9	<0.001	−0.541
Learning relationships	16.2 ± 2.1	14.5 ± 1.0	<0.001	−0.534
Bad news for patients and students	7.9 ± 1.1	7.0 ± 0.6	<0.001	−0.563
Support for patient-centered behaviors	11.8 ± 1.6	11.4 ± 1.3	<0.001	−0.412
Overall	86.8 ± 9.7	75.2 ± 4.4	<0.001	−0.596

*Wilcoxon signed-rank test.

Table 4. Comparison of the students, who have a chronically ill patient among family members or close friends, with the rest of the study group in terms of PCQ and C3 instrument scores.

Content area	Student scores (mean ± SD)
	Patient present (n = 42)	Patient not present (n = 102)	p*	Effect size
Role modeling
Initial PCQ	30.9 ± 2.6	30.4 ± 2.4	0.411	0.099
Final PCQ	24.3 ± 0.4	24.4 ± 0.6	0.259	−0.097
C3^β	65.9 ± 15.9	64.1 ± 18.6	0.886	0.402
Students’ experiences
Initial PCQ	45.5 ± 5.8	44.3 ± 5.6	0.124	0.104
Final PCQ	39.6 ± 3.6	39.4 ± 3.0	0.931	0.030
C3^β	35.0 ± 9.6	34.5 ± 5.4	0.554	0.032
Support for patient-centered behaviors
Initial PCQ	11.7 ± 1.6	11.4 ± 1.2	0.332	−0.120
Final PCQ	11.4 ± 1.4	12.1 ± 1.7	0.944	0
C3^β	9.7 ± 2.8	10.2 ± 2.7	0.388	−0.090

*Mann–Whitney U test.

^βOverall mean of fourth, fifth, and sixth year scores.

Table 5. Comparison of initial and final PCQ scores of the female and male students.

	Female	Male	p*	Effect size
Initial PCQ
Role modeling	30.2 ± 3.4	30.8 ± 3.4	0.198	−0.10
Students’ experiences	44.6 ± 4.5	44.7 ± 4.2	0.986	−0.01
Patients as objects	20.6 ± 3.4	20.4 ± 3.0	0.547	−0.05
Learning relationships	16.2 ± 2.2	16.2 ± 2.3	0.939	−0.01
Bad news for patients and students	7.8 ± 1.1	8.1 ± 1.2	0.173	−0.11
Support for patient-centered behaviors	11.9 ± 1.1	11.8 ± 1.3	0.744	−0.02
Overall	86.5 ± 5.5	87.5 ± 6.0	0.344	−0.08
Final PCQ
Role modeling	24.2 ± 1.9	24.3 ± 1.6	0.235	−0.09
Students’ experiences	39.7 ± 5.3	39.5 ± 3.9	0.971
Patients as objects	17.8 ± 2.7	18.2 ± 2.5	0.461	−0.06
Learning relationships	14.8 ± 4.1	14.2 ± 2.0	0.353	−0.07
Bad news for patients and students	7.0 ± 1.0	7.0 ± 1.0	0.730	−0.03
Support for patient-centered behaviors	11.4 ± 1.1	11.3 ± 1.3	0.384	−0.07
Overall	75.0 ± 5.6	75.2 ± 4.2	0.658	−0.036

*Mann–Whitney U test.

Table

C3 instrument	PCQ
Content area 1: Role modeling	Content area 1: Role modeling
1–3. Please indicate how often you observed (chief residents, senior residents or interns) communicate concern and interest in patients as unique persons.	1. Physicians should communicate concern and interest in patients as unique persons.
4–6. Please indicate how often you observed (chief residents, senior residents or interns) encourage patients’ participation in their own care.	2. Physicians should encourage patients’ participation in their own care.
7–9. Please indicate how often you observed (chief residents, senior residents or interns) take seriously patients’ concerns about their conditions or care.	3. Physicians should take seriously patients’ concerns about their conditions or care.
10–12. Please indicate how often you observed (chief residents, senior residents, or interns) develop good rapport with patients.	4. Physicians should develop good rapport with patients.
13–15. Please indicate how often you observed (chief residents, senior residents, or interns) explore emotional aspects of patients’ illnesses.	5. Physicians should explore emotional aspects of patients’ illnesses.
Content area 2: Students’ experiences	Content area 2: Students’ experiences
‘Patients as objects’ dimension	‘Patients as objects’ dimension
1. You overhear an attending physician discussing a patient’s case history with another attending or house officer. During the course of the conversation, the patient is referred to as a diagnosis.	1. Physicians should not refer to a patient as diagnoses.
2. When you describe social history information about a patient (e.g., career, hobbies) during ward rounds, you notice that the rest of the team is not paying attention.	2. Health-care teams should pay attention to social history information about a patient (e.g., career, hobbies) as much as medical history.
3. During rounds, your attending is paged to his office. His secretary has a patient present and wants to know when the attending will return. The attending replies, ‘Tell the patient to wait. I’ll get there when I get there’.	3. Physicians should take care of his/her appointments with patients and respect to patients’ time.
4. You hear students telling stories about patients. These stories tend to portray patients as diagnoses rather than unique human beings.	4. Medical students should portray the patients as unique persons rather than medical diagnoses.
5. Your ward team is rounding on a patient in his room when one of the consulting services arrives for this patient. Your attending and the consulting attending proceed to talk about the patient’s case as if the patient weren’t there.	5. When two or more physicians talk about a patient’s case in the same environment with the patient, they should respect to presence of the patient.
‘Learning relationships’ dimension 1. You hear students telling stories about patients. These stories tend to portray how the relationship with the patient affected the student(s) personally.	‘Learning relationships’ dimension 1. Medical students should be aware that the relationship with the patient affects the student(s) personally.
2. During your third or fourth year of medical school, an attending or house officer observes you while you interview a patient and provides you with feedback on your bedside manner.	2. Medical educators should observe students while they interview a patient and provide them with feedback.
3. During your third or fourth year of medical school, you are asked to interview a patient (either ‘real’ or ‘standardized’) and you are provided with feedback on how well you listened to the patient (either from the patient or an observer).	3. Interviews with patients (either ‘real’ or ‘standardized’) should take part within the medical education curriculum.
4. You are given advice from students in the classes ahead of you on what you need to do to succeed in medical school. This advice emphasizes the importance of good communication skills with patients.	4. Medical students should appreciate the importance of good communication skills with patients as a key for success in medical school.
‘Bad news for patients and students’ dimension	‘Bad news for patients and students’ dimension
1. During a rotation in the outpatient clinic, you have to convey bad news to a patient without any teaching or discussion about how to break the news in a caring manner.	1. Medical students should not have to convey bad news to a patient without any teaching or discussion about how to break the news in a caring manner.
2. You and your ward team have to convey bad news to a patient. Sometime after the bad news is conveyed, you find yourself having to answer many of the patient’s questions about the news without any teaching about how to talk to patients after they have been given bad news.	2. After the bad news is conveyed, medical students should not find themselves having to answer many of the patient’s questions about the news without any teaching about how to talk to patients after they have been given bad news.
Content area 3: Support for students’ own patient-centered behaviors	Content area 3: Support for students’ own patient-centered behaviors
1. In general, when I made an effort to develop rapport with patients, my instructors … me.	1. Instructors should encourage medical students when they made an effort to develop rapport with patients.
2. In general, when I made an effort to get to know patients as unique persons, my instructors … me.	2. Instructors should encourage medical students when they made an effort to get to know patients as unique persons.
3. In general, when I made an effort to legitimize patients’ concerns about their condition or care, my instructors … me.	3. Instructors should encourage medical students when they made an effort to legitimize patients’ concerns about their condition or care.

PCQ: Patient-centeredness questionnaire.

*The C3 instrument was originally developed by communication, curriculum and culture (C3) study group (ref. no: 20).