Attitudes towards the doctor-patient relationship: a prospective study in an Asian medical school

An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes

Introduction

The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information".

Methods

A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time.

Results

A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3).

Conclusion

Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

The Significance of Physician-Patient Communication on Telemedicine Patients' Health Outcomes: Evidence from Indonesia

The importance of physician-patient communication on patient health outcomes has been globally known. Poor communication in clinical settings, including in telemedicine visits, has been identified as a key barrier to successful medical consultation. This barrier is even more prevalent among people from linguistically and culturally diverse communities. This study investigated the influence of physician-patient communication on telemedicine patient health outcomes in Indonesia, a developing country with great linguistic and cultural diversity. This study utilized secondary data from a telemedicine utilization survey conducted during the coronavirus disease 2019 (COVID-19) pandemic. Socioeconomic factors and communication features were included as predictors of patients' health improvement. Logistic regressions were utilized to examine the significance of the communication features on patients' health. The analysis results indicated that five communication features including the adequacy of consultation length, a timely physician response, the provision of an explanation of the medication and possible side effects, the patient's ability to utter their physical condition and opinion regarding medication goals, and the patient's ability to comprehend physician explanations and instructions were significantly associated with the patient's health outcomes. Physicians and healthcare providers should focus on the provision of communication features revealed in this study to elevate the likelihood of improved health conditions in telemedicine patients.

Patient-centred care attitudes and knowledge: a national study of BDS students in New Zealand

OBJECTIVE

The aim of this study was to investigate the attitudes and knowledge towards patient-centred care among Bachelor of Dental Surgery (BDS) students in New Zealand.

METHOD

The study was a mixed methods cross-sectional national study of the BDS students in New Zealand. All 2021 BDS students at the New Zealand's National Centre for Dentistry, New Zealand, were recruited in the study. The Patient-Practitioner Orientation Scale (PPOS) questionnaire was used to evaluate the dental students' attitudes and knowledge of patient centred care. The students' perspectives on the BDS curriculum regarding patient-centred care were also collected. ANOVA and the Student's T-test were used to compare the difference among the BDS years, gender, and background.

RESULTS

A total of N = 277 (277/346; 80% response rate) students completed the study. Female students had higher scores than male students for sharing (difference = 0.19, 95% CI 0.04-0.34, P = 0.01), caring (difference = 0.15, 95% CI 0.01-0.29, P = 0.03) and PPOS (difference = 0.17, 95% CI 0.05-0.30, P < 0.01). Domestic students had higher scores than international students for caring (difference = 0.35, 95% CI 0.21-0.50, P < 0.01) and PPOS (difference = 0.22, 95% CI 0.08-0.35, P < 0.01). Three main themes of patient-centred care were extracted from the qualitative analysis of students' perspectives: (1) Understanding of the concept of patient-centred care, (2) Perception of the importance of patient-centred care in dentistry, and (3) Perspective on the curriculum about patient-centred care.

CONCLUSION

Most dental students favoured a patient-centred approach. According to dental students, the patient-centred care component of their education should be increased.

Attitudes of medical students in Khartoum, Sudan towards the doctor-patient relationship: a cross-sectional study

Background/Objectives

The doctor-patient relationship is essential to the delivery of high-quality medical care. A strong doctor-patient relationship that improves patient outcomes and satisfaction depends on effective communication. The purpose of this study was to assess medical students' attitudes toward the doctor-patient relationship during their clinical years at the University of Khartoum. We also looked at how gender and study year affected patient-centeredness.

Participants/Setting

The study was conducted on medical students in their clinical years from December 2020 to March 2021. Students were selected from years 3 to 6. A total of 353 medical students constituted the study sample.

Design

The cross-sectional study utilized the Patient Practitioner Orientation Scale (PPOS) for the measurement of student attitudes towards the doctor-patient relationship. PPOS scores are calculated as a mean score that ranges from 1 (indicating doctor or disease-centered inclinations) to 6 (indicating patient-centered or egalitarian inclinations). Medical students' demographic data was collected, including their gender, age and study year.

Results

A total of 313 students completed the survey (response rate: 89%). The average total PPOS score and the scores for the caring and sharing subscales for the entire cohort were 4.08 ± 0.53, 4.43 ± 0.58, and 3.72 ± 0.72, respectively. Female gender was significantly associated with more patient-centered attitudes (p < 0.001). When compared to the start of their clinical curriculum, students' attitudes were significantly more patient-centered by the conclusion of their studies (p < 0.001).

Conclusion

A satisfactory level of patient-centeredness was demonstrated by medical students at the University of Khartoum, and gender had an impact on this quality. Additional consideration should be given to the finding that students' orientations were more patient-centered in the caring dimension and less so in the sharing one. Once addressed, improvements in that area could create an environment that enhances attitudes among students in the sharing domain, with great potential gains to patients.

Factors affecting physicians' attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVES

Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians' attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.

DESIGN

A cross-sectional survey.

SETTING

Twelve hospitals in Beijing, China.

PARTICIPANTS

1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.

METHODS

This research used a survey containing a previously validated 6-point Likert scale called 'Chinese-revised Patient-Practitioner Orientation Scale' (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants' attitudes and to identify the sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care.

RESULTS

Gender, professional title (ie, seniority) and hospital type influence Chinese physicians' attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor-patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.

CONCLUSIONS

This research identified sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician-patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.

Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis

BACKGROUND

Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students' attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students' attitudes towards patient centred care. The secondary aim was to quantify healthcare students' attitudes towards patient centred care.

METHODS

An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to 'patient centred care', 'attitudes', and 'healthcare students'. Studies that quantitatively assessed healthcare students' attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students' attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students' attitudes towards patient centred care.

RESULTS

The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students' attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0-6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies).

CONCLUSIONS

Several different measurement tools have been used to assess healthcare students' attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.

Assessing attitudes of patient-centered care among chiropractic students at a South African university

OBJECTIVE

Patient-centered care (PCC) is acknowledged globally as a foundation of quality patient care and key to doctor-patient rapport. Student attitudes toward PCC have been assessed in some health professions and some international chiropractic institutions but is lacking in the South African chiropractic student context. This study explores this concept and compares these attitudes to other student groups.

METHODS

A cross-sectional survey was conducted on chiropractic students (years 1, 3, 5, and 6) at a South African institution. The 18-item Patient-Practitioner Orientation Scale (PPOS), with scoring 1-6 on a Likert scale, was used to evaluate the attitude toward PCC by students. Higher scores were representative of more patient-centeredness. Variables were analyzed to assess for associations between variables. Mean PPOS scores were calculated, and reliability and validity were tested using Cronbach α and factor analysis.

RESULTS

There were 100 respondents (68% response rate). The PPOS showed unsatisfactory reliability in our sample. The mean scores for the overall PPOS were 3.64 (SD = 0.46), the sharing subscale was 2.99 (SD = 0.61), and the caring subscale was 4.29 (SD = 0.58). There were small but suggestive trends noticed in PPOS scores based on age, sex, and year of study.

CONCLUSIONS

Chiropractic students from our university showed a general positive tendency toward PCC with no association between age and year of study. Sex showed some suggestive descriptive trends contrary to findings in other studies. The PPOS showed poor reliability in this study, warranting consideration with its use in similar contexts.

Gender Gap in Healthcare Worker—Patient Communication during the COVID-19 Pandemic: An Italian Observational Study

The value of the healthcare worker–patient communication has been well demonstrated and validated in several studies evidencing its relation to positive patient health outcomes, including better care response, simpler decision-making, better patient psychological well-being, and, therefore, considerable patient care satisfaction. The present study purposed to assess how patients perceived healthcare worker–patient communication during the COVID-19 pandemic and whether there were any gender-related differences among participants. From March 2020 to April 2020, an online questionnaire was administered to those who declared a patient’s condition in this period. The data considered included data on gender and a Quality of Communication questionnaire (QOC). A total of 120 patients were recruited online. Of these, 52 (43.33%) were females and 68 (56.67%) were males. Significant differences were recorded between females and males in the QOC questionnaire as regards Item no.2 (p = 0.033), Item no.6 (p = 0.007), Item no.11 (p = 0.013), Item no.12 (p = 0.003), Item no.13 (p = 0.002), Item no.15 (p = 0.008), and Item no.16 (p = 0.037), respectively. The potentially different elements between the two sexes considered were assessed in: Component 1: the need to be completely informed about their own health condition, and Component 2: the need to receive authentic and sincere communication from the healthcare worker involved. In light of the present findings, it has emerged that male patients seemed to be more active and positive in effective healthcare worker–patient communication.

Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants

BACKGROUND

In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population.

DESIGN

Observational cross-sectional study.

METHODS

Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5).

RESULTS

Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant.

CONCLUSION

Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.

Preference for patient-centered communication among the citizens of the Visegrad countries

OBJECTIVES

The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider.

METHODS

The patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed.

RESULTS

Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries.

CONCLUSIONS

Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries.

PRACTICE IMPLICATIONS

These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.

Clinical profiles of patients referred to an ear, nose and throat specialist clinic via community mobile hearing clinic in Singapore

Background:

Community-based audiology service is new to the Singapore’s health-care landscape. Cases deemed unsuitable to remain under audiologists’ management in the community are referred to ear, nose and throat (ENT) specialists.

Objectives:

Analysis of the clinical profiles for these referred cases revealed the local community burden of otological and auditory conditions.

Methods:

This was a retrospective, cross-sectional pilot study. Clinical records of 375 patients who were seen by audiologists at a community-based mobile hearing clinic (MHC) and warranted ENT specialist referrals were extracted for descriptive analysis.

Results:

A total of 83.73% ( n=314) of patients attended their ENT appointments as advised by audiologists. Most patients (57.07%, n=234) had one condition diagnosed by the ENT specialist. One patient had four ENT conditions. Twenty-two types of otological conditions were diagnosed. Chronic suppurative otitis media, otitis externa, impacted cerumen and otitis media with effusion made up the four most frequently seen conditions in this subgroup. Twelve types of auditory conditions were diagnosed, with asymmetrical hearing loss topping the list. Sixteen types of other ENT conditions were diagnosed. Four incidental findings of vestibular schwannoma were reported.

Conclusion:

Many of the otological conditions diagnosed were chronic. Auditory conditions were predominantly hearing loss. Yet, they were found unnoticed or untreated by patients at the time of their visit to the MHC. This community-based audiology clinic had a catalytic effect on promoting timely or even early otological/hearing diagnosis and treatment. Understanding the prevailing ENT conditions of our wider population indicates the potential for growing community-based hearing health-care provision.

Empathy and attitude toward communication skill learning as a predictor of patient-centered attitude: a cross-sectional study of dental students in Korea

BACKGROUND

Enhancing medical students' practice of patient-centered care is a goal of medical schools. In addition to exploring the demographic and academic factors of the students, it is necessary to identify other attitudes and perceptions that may influence the student's patient-centered attitude and inclination toward communication skill learning. This study aimed to assess patient-centered attitudes among dental students in Korea and identify the association between the students' characteristics and empathy, communication skill learning attitude, and patient-centered attitude.

METHODS

Data were collected via a cross-sectional online survey, and 312 dental students were included in the analyses. The study participants completed the Patient-Practitioner Orientation Scale (PPOS), the Interpersonal Reactivity Index (IRI), and the Communication Skills Attitude Scale (CSAS). Analyses were performed using independent samples' t-tests, hierarchical multi-variable regression, and ANOVA with a post-hoc Tukey test.

RESULTS

The students tend to be moderately patient-oriented toward the sharing subscale of PPOS score (M = 3.78, standard deviation [SD] = 0.54) and slightly more patient-centered toward the caring subscale of PPOS score (M = 4.41, SD = 0.52) of patient-centered attitudes. Being a female and a shorter academic period in dentistry were associated with attitudes toward patient-centered care. Empathy and positive attitude toward learning communication skills were also related to a patient-centered attitude, and among aspects of empathy, "empathic concern" had the greatest significant impact on patient-centered attitude.

CONCLUSIONS

Gender, academic period, empathy, and attitudes on learning communication skills were important influencing factors of patient-centered attitudes. Patient-centered attitude can and must be taught. Education programs should focus on enhancing empathy, emphasizing positive attitudes on learning communication skills, and conducting follow-up educational sessions to prevent students from becoming less patient-centered with an increase in duration of their academic period.

Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico

BACKGROUND

Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy.

METHODS

A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors.

RESULTS

A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed.

CONCLUSIONS

Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.

Bridging the intergenerational gap: the outcomes of a student-initiated, longitudinal, inter-professional, inter-generational home visit program

BACKGROUND

Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen.

METHODS

Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients' reported satisfaction and clinical outcomes were also assessed.

RESULTS

Two hundred twenty-six healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1 and 62.4% respectively. One hundred six patients participated in TriGen. There was a significant increase in Kogan's Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5-16.2, p <  0.001) and 8.3 (95%CI: 6.2-10.3, p <  0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. Fifty-one patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier.

CONCLUSION

TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.

A partnership-oriented and culturally-sensitive communication style of doctors can impact the health outcomes of patients with chronic illnesses in Indonesia

OBJECTIVES

A partnership-oriented communication style is globally recommended for medical practice. A culturally-sensitive doctor-patient communication guideline is also needed for Southeast Asia. The 'Greet-Invite-Discuss' guideline was established and tested with primary care doctors and their patients in Indonesia.

METHODS

In this mixed-methods study, doctors were trained according to the 'Greet-Invite-Discuss' guideline, while patients received standard treatment. Two groups of fifteen doctors were assigned to have consultations with 45 patients with hypertension or 51 patients with type-2 diabetes mellitus. Doctors' self-assessment and patients' perceptions and their clinical outcomes were longitudinally measured. Six focus group discussions were conducted to explore doctors' and patients' experiences.

RESULTS

Doctors' self-assessments and patients' perceptions of doctors' communication skills increased significantly (p < 0.05). Moreover, patients' blood pressure or fasting blood glucose levels decreased significantly (p < 0.05), except the two-hour blood glucose levels (NS). Qualitatively, doctors demonstrated more partnership and culturally-sensitive communication, and patients expressed more satisfaction, increased comprehension and self-management, of their chronic illnesses.

CONCLUSIONS

The 'Greet-Invite-Discuss' guideline was useful for primary care doctors for a more partnership-oriented and culturally-sensitive communication with patients in chronic care management.

PRACTICE IMPLICATIONS

Using a partnership-oriented and culturally-sensitive communication guideline, doctors can improve their communication skills with their patients towards optimum health outcomes.

Impact on core values of family medicine from a 2-year Master's programme in Gezira, Sudan: observational study

BACKGROUND

Training of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master's programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates' adherence to some core values of family medicine.

METHODS

This is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians' attitude towards patient-centeredness. Practice based data from individual patients' consultations and self-assessment methods were used to assess physicians' adherence to core values.

RESULTS

At the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p <  0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients' medical history (p <  0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007).

CONCLUSIONS

The GFMP Master's programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.

Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China

OBJECTIVES

Assessing medical students' attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform.

METHODS

A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students' attitudes. The medical students' demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category.

RESULTS

A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for 'Caring' (including patients' preferences into the decision-making process) than for 'Sharing' (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores. Student category (P < 0.05) was associated with 'Sharing' and 'Caring' scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores, Students without siblings (p < 0.07) were associated with the higher 'Sharing' subscale scores.

CONCLUSIONS

In China, gender has a significant impact on medical students' patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.

Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey

Background

Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students' attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs.

Objective

To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide.

Methods

We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students' patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores.

Results

There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17-58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals.

Conclusion

This is the first international study assessing students' attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.

Medical Students' Perceptions of the Doctor-Patient Relationship: A Cross-Sectional Study from Saudi Arabia

Introduction The physician-patient relationship is at the heart of the art of medicine. Patient-centered care is rapidly evolving as the standard of care as well as the optimal vehicle to achieve high-quality healthcare and good clinical outcomes. This study aims to examine the attitudes of pre-clinical (third-year) students from Alfaisal University (Riyadh, Saudi Arabia) toward the physician-patient relationship. Methods This cross-sectional study took place during the spring 2017 academic year. All third-year students (n=210) were requested to voluntarily complete an online and anonymous questionnaire. The questionnaire covered students' demographical characteristics (gender, nationality, and cumulative grade point average) and their response to a previously validated instrument, the Patient-Practitioner Orientation Scale (PPOS), which explores the attitudes of medical students toward the doctor-patient relationship. Results In total, 132 students participated in the survey (n=132/210) with an overall response rate of 62.9%. Most respondents were female (56.8%), non-Saudi citizens (53.0%), and high achievers (70.5%). Most of the mean scores on the PPOS statements indicated patient-centered attitudes - that is, mean scores were higher than "3". The mean score for the overall PPOS was 4.0 ± 1.5, whereas the mean scores for the sharing and caring domains were 4.2 ± 1.5 and 3.8 ± 1.4, respectively. Univariate correlations between the students' demographics and their mean scores for the sharing domain, caring domain, and overall PPOS showed no statistically significant differences (p > 0.05). Conclusion The pre-clinical medical students showed favorable patient-centered attitudes. There were no statistically significant differences between students' demographics (gender, nationality, and academic performance) and PPOS scores (sharing domain, caring domain and overall score).

Changes in patient-centered attitude and confidence in communicating with patients: a longitudinal study of resident physicians

BACKGROUND

Patient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians' patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits.

METHODS

The study participants were resident physicians at a university hospital in Tokyo. Participants' patient-centered attitudes (as measured by the Patient-Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95).

RESULTS

PPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients' expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score.

CONCLUSIONS

As seen in previous studies of medical students, resident physicians' patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians' confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians' attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.

Centração no paciente: Contributo para o estudo de adaptação da patient-practitioner orientation scale (PPOS)

Objetivo

Este estudo teve como objetivo traduzir e contribuir para a adaptação para a população portuguesa (Português Europeu) da Patient-Practitioner Orientation Scale (PPOS).

Método

Após o processo de tradução e de pré-teste, a escala foi aplicada a 593 estudantes do 1º ao 6º ano do curso de Medicina em várias Universidades de Portugal Continental. A validade do construto e a fiabilidade do instrumento foram aferidas através da análise fatorial exploratória (ACP) e confirmatória (AFC), e do cálculo do coeficiente alpha de Cronbach.

Resultados

A versão final explica 31.54% da variância total e confirma a estrutura em dois fatores: Caring, (19.56% da variância) e Sharing (11.98% da variância). Os itens 2 e 4 apresentaram inconsistências com os fatores definidos à priori (versão original do instrumento), os itens 9 e 17 obtiveram cargas fatoriais inferiores a .3, e o item 3 registou uma diferença inferior a .1 entre as cargas fatoriais para os dois domínios. Os coeficientes de alpha de Cronbach foram .65, .50 e .56 para a escala total, e subscalas Caring e Sharing, respetivamente. A AFC revelou um bom ajustamento global do modelo de medida (χ²(132, N = 593) = 344.28, p < .001; χ²/gl = 2.61; GFI = .93; AGFI = .92; CFI = .87; NNFI = .81; SRMR = .084; RMSEA = .05, 95% CI [0.045, 0.059], p = .293). As análises exploratórias posteriores sugerem a possibilidade de melhoria dos índices de validade e de fiabilidade da escala total e da sub-escala Caring, com a retirada de itens específicos.

Conclusão

Não obstante as fragilidades encontradas no que concerne à fiabilidade e validade da PPOS-P para uma amostra de estudantes portugueses de Medicina, este estudo representa um contributo científico para a adaptação da escala, que pode ser considerada para efeitos de avaliação de atitudes de centração no paciente nos contextos da educação médica e da investigação.

Patient-Centered Beliefs Among Patients and Providers in Kazakhstan

BACKGROUND

Health services in Kazakhstan have undergone radical reforms since its independence in 1991, but levels of dissatisfaction among patients remain high. We investigated whether healthcare providers and patients at one hospital in Astana, Kazakhstan, believe the doctor-patient interaction should be doctor-centered vs patient-centered.

METHODS

We conducted a cross-sectional study of the responses to various surveys of 200 patients (response rate, 74%) and 201 healthcare providers (response rate, 86%) in a general hospital in Astana, Kazakhstan. The participants completed a questionnaire containing the Patient-Practitioner Orientation Scale (PPOS) and scales assessing life and job satisfaction, job effort-job reward balance, and patient evaluation of communication. Analyses were restricted to those with valid data on the variables age, sex, and PPOS (147 providers and 150 patients).

RESULTS

An overwhelming majority of doctors (80%), nurses (87%), and patients (93%) were doctor-oriented. Among patients, higher patient-oriented scores were statistically significantly associated with higher satisfaction with communication with healthcare providers (P=0.038) and with life satisfaction (P=0.009).

CONCLUSION

Only a small percentage of doctors, nurses, and patients reported that their interaction should be patient-centered. This congruence between providers and patients does not explain dissatisfaction, but the finding that patient-centered patients were more satisfied suggests an area for improvement.

Medical and psychosocial factors associated with antibiotic prescribing in primary care: survey questionnaire and factor analysis

BACKGROUND

Acute upper respiratory infections (AURI) are the leading causes of antibiotic prescribing in primary care although antibiotics are often not indicated.

AIM

To gain an understanding of the knowledge, attitudes, and practices (KAP) of GPs in Singapore and the associated latent factors to guide the implementation of an effective programme to reduce antibiotic use in primary care.

DESIGN AND SETTING

An anonymous survey on the KAP of antibiotic use in AURI of GPs in Singapore.

METHOD

KAP survey questionnaires were posted to all GPs from a database. To ascertain the latent factors affecting prescribing patterns, exploratory factor analysis was performed.

RESULTS

Among 427 responses, 351 (82.2%) were from GPs working in private practice. It was found that 58.4% of GPs in the private versus 72.4% of those in the public sector recognised that >80% of AURIs were caused by viruses (P = 0.02). The majority of GPs (353/427; 82.7%) felt that antibiotics were overprescribed in primary care. Significant factors associated with low antibiotic prescribing were good medical knowledge and clinical competency (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI] = 2.4 to 4.3), good clinical practice (aOR 2.7 [95% CI = 2.0 to 3.6]), availability of diagnostic tests (aOR 1.4 [95% CI = 1.1 to 1.8]), and desire to improve clinical practice (aOR 1.5 [95% CI = 1.2 to 1.9]). The conservative practice of giving antibiotics 'to be on the safe side' is significantly less likely to be associated with low antibiotic prescribing (aOR 0.7 [95% CI = 0.5 to 0.9]).

CONCLUSION

This is the first KAP survey on antibiotic prescribing for AURI among GPs in Singapore. With the latent factors identified, future interventions should be directed at addressing these factors to reduce inappropriate antibiotic prescribing.

Efficacy and tolerability of exenatide twice daily and exenatide once weekly in Asian versus White patients with type 2 diabetes mellitus: A pooled analysis

AIMS

The efficacy and safety of exenatide twice daily (BID) and once weekly (QW) were assessed in Asian versus White patients with type 2 diabetes mellitus (T2DM).

METHODS

This post-hoc pooled analysis evaluated patients receiving 10μg exenatide BID for 12-30 weeks or 2mg exenatide QW for 24-30 weeks in exenatide clinical development program trials. Race was self-identified.

RESULTS

A total of 4625 patients were included (exenatide BID: Asian, n=787; White, n=2223; exenatide QW: Asian, n=511; White, n=1104). At study end, glycated hemoglobin (HbA1c), fasting glucose (FG), body weight, post-prandial glucose (PPG), and PPG excursions were significantly reduced (all P<0.0001 vs baseline). For exenatide BID, HbA1c reduction was greater in Asians (P<0.0001 vs Whites), whereas HbA1c reduction did not differ by race for exenatide QW. FG reduction did not differ by race for either exenatide formulation. Weight reduction was significantly greater in Whites (P<0.0001 vs Asians), regardless of exenatide formulation. PPG reduction was greater in Asians (P<0.0001 vs Whites) for exenatide BID but did not differ by race for exenatide QW. For exenatide BID, reductions in PPG excursions for all meals were significantly greater in Asians (P<0.0001 vs Whites), whereas only post-breakfast and post-lunch excursions were significantly greater in Asians for exenatide QW (P=0.0009 and P=0.0189 vs Whites, respectively). Common adverse events included nausea, headache, and diarrhea.

CONCLUSIONS

Exenatide BID and QW improved glycemic control, including PPG, in Asian and White patients with T2DM. With exenatide BID, Asian patients exhibited significantly greater reductions in HbA1c and PPG than White patients. Both exenatide formulations were well tolerated in both groups.

A Methodological Review of the Assessment of Humanism in Medical Students

BACKGROUND

Humanism is a complex construct that defies simplistic measurement. How educators measure humanism shapes understanding and implications for learners. This systematic review sought to address the following questions: How do medical educators assess humanism in medical students, and how does the measurement impact the understanding of humanism in undergraduate medical education (UME)?

METHOD

Using the IECARES (integrity, excellence, compassion, altruism, respect, empathy, and service) Gold Foundation framework, a search of English literature databases from 2000 to 2013 on assessment of humanism in medical students revealed more than 900 articles, of which 155 met criteria for analysis. Using descriptive statistics, articles and assessments were analyzed for construct measured, study design, assessment method, instrument type, perspective/source of assessment, student level, validity evidence, and national context.

RESULTS

Of 202 assessments reported in 155 articles, 162 (80%) used surveys; 164 (81%) used student self-reports. One hundred nine articles (70%) included only one humanism construct. Empathy was the most prevalent construct present in 96 (62%); 49 (51%) of those used a single instrument. One hundred fifteen (74%) used exclusively quantitative data; only 48 (31%) used a longitudinal design. Construct underrepresentation was identified as a threat to validity in half of the assessments. Articles included 34 countries; 87 (56%) were from North America.

CONCLUSIONS

Assessment of humanism in UME incorporates a limited scope of a complex construct, often relying on single quantitative measures from self-reported survey instruments. This highlights the need for multiple methods, perspectives, and longitudinal designs to strengthen the validity of humanism assessments.

Resident physicians' attitudes and confidence in communicating with patients: a pilot study at a Japanese university hospital

OBJECTIVE

This study aimed to explore the relationships among physicians' confidence in conducting medical interviews, their attitudes toward the patient-physician relationship, and undergraduate training in communication skills among resident physicians in Japan.

METHODS

Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary-Cambridge Guide. Additionally, participants' attitudes toward the patient-physician relationship (Patient-Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire.

RESULTS

The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS.

CONCLUSION

These scales could be useful tools to measure physicians' confidence and attitudes in communicating with patients and to explore their changes through medical education.

PRACTICE IMPLICATIONS

Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment.

An Australian survey of audiologists' preferences for patient-centredness

OBJECTIVE

Patient-centredness is becoming a core value of health services worldwide, however it remains largely unexplored in audiology. This study investigated audiologists' preferences for patient-centredness and identified factors that explain audiologists' preferences for patient-centredness.

DESIGN

All members of the Audiological Society of Australia received two questionnaires: (1) a descriptive questionnaire (e.g. age, gender, place of residence, years in practice, employment characteristics), and (2) a modified patient-practitioner orientation scale (PPOS; Krupat et al, 2000) which measures preferences for two aspects of patient-centredness, sharing and caring.

STUDY SAMPLE

In total 663 (46%) audiologists returned both questionnaires fully completed.

RESULTS

Mean PPOS scores indicated that audiologists prefer patient-centredness. Linear regression modelling identified that older audiologists, that had practiced longer, and who worked in community education, industrial audiology, or teaching had a significantly greater preference for patient-centredness than their peers. In contrast, audiologists who practiced in a private environment and who worked in the area of assessment of adults had a significantly lesser preference for patient-centredness than their peers.

CONCLUSIONS

Audiologists prefer client-centredness and age, years of experience, and employment characteristics can partly explain preferences for patient-centredness. Future research should explore the relationships between patient-centredness and intervention outcomes in audiology.

Assessment of nursing students and nurses' orientation towards patient-centeredness

BACKGROUND

Being patient centered is a core value for nursing. Patient centered-care has been related to patient and health provider satisfaction, better health outcomes, higher quality of care and more efficient health care delivery.

OBJECTIVES

The purpose was to assess the orientation adopted by nurses and students in patient care, using The Patient-Practitioner Orientation Scale, as well as to compare the results between resident nurses and students from different academic years.

SETTINGS

Public School of Nursing and a Central Hospital, in Lisbon (Portugal).

PARTICIPANTS

Students in the first, second and fourth year of nursing school and nurses participated in the study.

METHODS

For data collection, we used The Patient-Practitioner Orientation Scale (European Portuguese version), an instrument designed to measure individual preferences toward the dimension of caring a sharing in health professional-patient relationship. Students and nurses also filled out two additional questions about their perception of competence in technical and communication skills. Additional demographic information was also collected, including gender, age, academic year and length of professional experience.

RESULTS

A total of 525 students (84.7% female) and 108 nurses (77.8% female) participated in this study. In general, caring sub-scores, measuring the preference of about attending to patient emotional aspects, were higher than sharing sub-scores, measuring beliefs about giving information and perceiving patient as a member of the health team. Students were significantly more patient-centered throughout their nursing education (p<0.001). Comparing to students in the second and fourth academic years (p<0.001) nurses' scores were significantly lower both in total PPOS and in caring and sharing subscales.

CONCLUSIONS

These results reinforce the idea that patient centeredness may be developed in academic context. The scores obtained highlight the importance of studies that aim to identify factors that may explain the decrease of patient centeredness in professional practice.

Cross-cultural validation of the Patient-Practitioner Orientation Scale (PPOS)

OBJECTIVES

Translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) for use in Brazil.

METHODS

The PPOS was translated to Portuguese using a modified Delphi technique. The final version was applied to 360 participants. Reliability (test-retest and internal consistency) and construct validity (explanatory and confirmatory factor analysis) were assessed.

RESULTS

Only two items did not reach pre-established criteria agreement in Delphi technique. In pre-testing, seven items were modified. Internal consistency (Cronbach's alpha=0.605) and test-retest reliability (intraclass correlation coefficient=0.670) were adequate. In explanatory factor analysis, one item did not achieve a loading factor, one item was considered factorially complex and two items were inconsistent with a priori factors. Confirmatory factor analysis provided an acceptable adjustment for the observed variables (χ(2)/df=2.33; GFI=0.91; AGFI=0.89; CFI=0.84; NFI=0.75; NNFI=0.81; RMSEA=0.062 (p=0.016) and SRMR=0.065).

CONCLUSIONS

The Brazilian version PPOS (B-PPOS) showed acceptable validity and adequate reliability.

PRACTICE IMPLICATIONS

The use of the B-PPOS in national and cross-cultural studies may contribute to the evaluation and monitoring of the attitudes of doctors, medical students and patients toward their professional relationships in research and practice.

Doctors in a Southeast Asian country communicate sub-optimally regardless of patients' educational background

OBJECTIVE

To explore the relationship between the style of doctor-patient communication and patients' educational background in a Southeast Asian teaching hospital setting using the Roter Interaction Analysis System (RIAS).

METHODS

We analyzed a total of 245 audio-taped consultations involving 30 internal medicine residents with 7-10 patients each in the internal medicine outpatient clinics. The patients were categorized into a group with a high and a group with a low educational level. We ranked the data into 41 RIAS utterances and RIAS-based composite categories in order of observed frequency during consultations.

RESULTS

The residents invariantly used a paternalistic style irrespective of patients' educational background. The RIAS utterances and the composite categories show no significant relationship between communication style and patients' educational level.

CONCLUSION

Doctors in a Southeast Asian country use a paternalistic communication style during consultations, regardless of patients' educational background.

PRACTICE IMPLICATION

To approach a more partnership doctor-patient communication, culture and clinical environment concern of Southeast Asian should be further investigated.

Caring for underserved patients through neighborhood health screening: outcomes of a longitudinal, interprofessional, student-run home visit program in Singapore

PURPOSE

Service learning, an effective vehicle for teaching undergraduate public health while providing underserved communities with medical care, is not well established in Asia. The authors evaluated a service learning program, Neighborhood Health Screening (NHS), in Singapore.

METHOD

Medical and nursing undergraduate students provided in-home medical services to patients in a low-income neighborhood (January-June 2010). The authors assessed student-reported pedagogical effectiveness in nine domains, asked students for qualitative feedback on their experiences, assessed patients' satisfaction with NHS, and tracked clinical outcomes.

RESULTS

Of the 240 medical and 34 nursing students who participated, 222 (93%) and 34 (100%), respectively, completed the questionnaire; 136 of the medical students (57%) also provided qualitative feedback. Most students felt NHS was beneficial across all domains. Male medical students were less likely to report increased understanding of deficiencies in the health care system and long-term management of chronic disease; preclinical students were more likely to report improvements in comprehending ethical issues, critical thinking and action skills, and gaining and applying knowledge. Qualitative feedback supported quantitative findings. Patients were satisfied with NHS: 266 (75%) agreed that NHS improved their health, and 301 (85%) felt NHS provided sufficient time to address their issues. After a single year, amongst patients with known hypertension, treatment increased from 63% to 93% (P < .001), and blood pressure control amongst those who were on treatment improved from 42% to 79% (P < .001).

CONCLUSIONS

Service learning can make an important contribution to medical teaching and patient care in Asia.

Doctor-patient communication in a Southeast Asian setting: the conflict between ideal and reality

Doctor-patient communication has been extensively studied in non-Western contexts and in relation to patients' cultural and education backgrounds. This study explores the perceived ideal communication style for doctor-patient consultations and the reality of actual practice in a Southeast Asian context. We conducted the study in a teaching hospital in Indonesia, using a qualitative and a quantitative design. In-depth interviews were conducted with ten internal medicine specialists, ten internal medicine residents, 16 patients in two groups based on education level and ten most senior medical students. The contributions of doctors and patients to the communication during consultations were observed and rated quantitatively by thirty internal medicine residents, 393 patients with different educational backgrounds and ten senior medical students. The 'informed and shared decision making' is the central observation in this quantitative study. The results of the interviews showed that Southeast Asian stakeholders are in favor of a partnership style of communication and revealed barriers to achieving this: doctors and patients are not prepared for a participatory style and high patient load due to an inefficient health care system does not allow sufficient time for this type of communication. The results of the quantitative study showed a sharp contrast between observed and ideal communication styles. A paternalistic style seems to prevail, irrespective of patients' educational background. We found a sharp conflict between ideal and reality concerning doctor-patient communication in a Southeast Asian context. Further studies should examine ways to change the prevailing communication style in the desired direction.

The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening

Introduction: We assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore’s Yong Loo Lin School of Medicine (NUS YLLSoM). Materials and Methods: We conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS. Results: The participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score. Conclusion: PHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students. Keywords: Medical education, Student-led, Voluntarism and skills

Comparison of Patient-centeredness Changes between Medical School Graduates and Medical Students after Psychiatric Clerkship

PURPOSE

The aim of this study was to compare patient-centeredness changes between medical school graduates and medical students after a psychiatric clinical clerkship.

METHODS

We focused on 40 medical school graduates. We received permission to use data from a 2006 study on patient-centeredness of 94 medical students. The following was repeated before and after clerkship: Minnesota Multiphasic Personality Inventory (MMPI), Meyers-Briggs type indicator (MBTI), Patient-practitioner Orientation Scale (PPOS) and Authoritarian Personality (AP) scale.

RESULTS

In the 2006 study on patient-centeredness of medical students, the AP scores were significantly lower than before clerkship and the PPOS scores were significantly higher than before clerkship. AP score changes were related to MBTI, correlated with MMPI subscales, but inversely correlated with PPOS changes. In this study, the change in PPOS scores was not significant after clerkship in case of medical school graduates. AP score changes inversely correlated with PPOS changes, but neither correlated with MMPI subscales or MBTI.

CONCLUSION

Considering previous findings, medical school graduates tend to be more patient-centered than medical students, but medical students can adopt a more patient-centered attitude than graduates through a psychiatric clinical clerkship.