A gender-specific evaluation of a care-oriented curricular change in a Dutch medical school

Figures & data

Table

Practice points

The increasing number of chronically ill patients needs doctors with a stronger care and patient centredness. Medical education has to develop and evaluate instructional formats to prepare future doctors to provide care tailored to these patients. We evaluated a patient-oriented educational programme, consisting of longitudinal meetings with a chronic patient, assignments and debriefing sessions. The study shows a consistent trend towards increased cure orientations (rather than care), which was unaffected by the educational intervention. We are in need of further studies examining how educational interventions can foster a care-oriented attitude in students.

Table 1.  Total number of students in the cohorts studied and the number of participating students

			Number of respondents
Year	Care-oriented curriculum intervention	Total number of third-year students	At year start	At year end	At year start and end
2003/2004	+	290	220 (76%)	132 (46%)	112 (39%)
2004/2005	+	293	271 (93%)	259 (88%)	238 (81%)
2005/2006	–	345	232 (67%)	181 (53%)	149 (43%)

Table 2.  Attitudes of medical students as measured by the Ideal Physician questionnaire. The results of one-factor (care versus cure orientation) and three-factor solutions (a psychosocial versus biomedical; an empathic versus distant; and a rational versus emotional factor), based upon factor loadings of principal factor analyses with oblique rotation in pooled September/October data in three cohorts (n = 673)

Ideal physician	One-factor solution	Three-factor solution
questionnaire items	Care	Psychosocial	Empathic	Rational
Hierarchical (democratic)	0.35^a	0.22	0.30^a	−0.01
Distant (committed)	0.29	−0.01	0.59^a	−0.01
Disease-centred (person-centred)	0.44^a	0.34^a	0.23	−0.00
Reticent (open)	0.20	−0.10	0.53^a	−0.02
Soloist (team member)	0.11	0.04	0.37^a	0.15
Scientist (care provider)	0.28	0.05	0.23	−0.14
Businesslike (considerate)	0.54^a	0.09	0.54^a	−0.24
Objective (empathic)	0.55^a	0.11	0.41^a	−0.29
Analysing (integrating)	0.38^a	0.19	0.20	−0.14
Specialist (general practitioner)	0.43^a	0.56^a	−0.06	−0.02
Somatic (psychosocial)	0.47^a	0.48^a	0.16	0.01
Intervening (contemplative)	0.33^a	0.47^a	−0.06	0.02
Technician (confessor)	0.52^a	0.39^a	0.07	−0.19
Common sense (compassionate)	0.54^a	−0.10	0.19	−0.66^a
Logical (intuitive)	0.41^a	0.06	−0.06	−0.50^a
Rational (emotional)	0.54^a	0.09	−0.07	−0.66^a
Conducting (following)	0.41^a	0.29	−0.16	−0.33^a
Certain (doubtful)	0.21	0.22	−0.38^a	−0.29

Note: ^aFactor loadings > 0.30 or <−0.30. The scores on the items with such loadings were used to calculate compound scores.

Figure 1. Mean care orientation of third-year medical students who participated in the patient-oriented programme (2003/2004 and 2004/2005) and who did not participate in this programme (2005/2006) (theoretical minimum and maximum, 0 and 7).

Figure 2. Mean care orientation of medical students in their third (2004–2005) and fourth years (2005–2006); all experienced the YPP curricular change in their third year (n = 82).