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Buono N, Sassier B, Thulesius H, Hoffman R, Nabbe P, Petek D, Le Reste JY. Translation of the working alliance inventory short revised into Italian using a Delphi procedure and a forward-backward translation. Front Med (Lausanne) 2024; 10:1236273. [PMID: 38274448 PMCID: PMC10808585 DOI: 10.3389/fmed.2023.1236273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Enhancing treatment adherence, especially for chronic diseases, can be achieved through therapeutic alliance, potentially elevating the quality of care. An instrument to evaluate the therapeutic alliance could be beneficial in routine clinical settings, educational environments, and extensive research efforts at national and European levels. In this study, we translated therapist and patient versions of the Working Alliance Inventory Short Revised (WAI-SR) into Italian. Methodology An email-based Delphi method was employed for the English-to-Italian translation, incorporating a forward-backward process. The initial translation team comprised two Italian family physicians proficient in English, a linguist, and a psychiatrist. The forward translation was then reviewed by 18 Italian family physicians through a Delphi process and was subjected to a backward translation by two Italian English teachers. A cultural correspondence was subsequently identified to adjust translations within a national and international framework. Results All 18 experts fully engaged in the Delphi process, and consensus was achieved by the second Delphi round. A cultural check checked for discrepancies regarding linguistic consistency with other translations and found no difference. Conclusion This Italian translation of the WAI-SR is expected to support Italian family physicians aiming to enhance their clinical practice and therapeutic outcomes. It could also be a valuable tool for Italian medical students to foster therapeutic relationships and improve their communication skills.
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Affiliation(s)
- Nicola Buono
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
| | - Béatrice Sassier
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Hans Thulesius
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Patrice Nabbe
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jean Yves Le Reste
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
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Ardenghi S, Russo S, Rampoldi G, Bani M, Strepparava MG. Medical students' attitude toward patient-centeredness: A longitudinal study. PATIENT EDUCATION AND COUNSELING 2024; 118:108003. [PMID: 37820544 DOI: 10.1016/j.pec.2023.108003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES This study explored the trajectories of patient-centered orientation in a sample of Italian medical students throughout medical school. METHODS Four consecutive student cohorts were longitudinally assessed at the second (T0) and fifth year (T1) of medical school. Students completed a questionnaire including demographics and the Italian validated version of the Patient-Practitioner Orientation Scale. RESULTS 352 students completed both administrations. Students became more patient-centered in terms of Sharing along the course of their clinical curriculum, whereas there were no significant changes in Caring. Groups with distinct developmental trajectory patterns of both Caring and Sharing were identified. Students high in patient-centeredness at T0 reported significantly lower scores at T1 while students with lower scores at T0 significantly increased from the first to the last measurement. Female students significantly outscored their male colleagues on Caring and Sharing in both administrations. CONCLUSIONS Findings call for innovative education strategies to sustain patient-centeredness attitudes in medical students entering hospital-based clinical medicine. Further research is needed to identify characteristics of the medical curriculum that are primarily involved in fostering students' patient-centeredness. PRACTICE IMPLICATIONS Including the assessment and monitoring of patient-centeredness throughout the medical school can inform tailored education aiming to foster this dimension.
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Affiliation(s)
- Stefano Ardenghi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Selena Russo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Rampoldi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marco Bani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
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Grilo AM, Vinagre G, dos Santos MC, Martinho JF, Gomes AI. Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study. Healthcare (Basel) 2023; 11:2803. [PMID: 37893877 PMCID: PMC10606137 DOI: 10.3390/healthcare11202803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC—Health & Technology Research Center, Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
| | - Graça Vinagre
- Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1990-096 Lisboa, Portugal;
| | - Margarida Custódio dos Santos
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
- Escola Superior de Tecnologia da Saúde, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Joana Ferreira Martinho
- Câmara Municipal de Oliveira do Bairro, Ed. Paços do Concelho, Praça do Município, 3770-851 Oliveira do Bairro, Portugal;
| | - Ana Isabel Gomes
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal;
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Guan G, Mei L, Yu C, Tan Y, Han C. Patient-centred care attitudes and knowledge: a national study of BDS students in New Zealand. BMC MEDICAL EDUCATION 2023; 23:516. [PMID: 37464392 DOI: 10.1186/s12909-023-04496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
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.
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Affiliation(s)
- Guangzhao Guan
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Li Mei
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand
| | - Chuting Yu
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Yue Tan
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Chengbing Han
- Department of Oral and Maxillofacial Surgery, Weifang People's Hospital, Weifang, Shandong, China.
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Haiba AM, Haiba MM. Attitudes of medical students in Khartoum, Sudan towards the doctor-patient relationship: a cross-sectional study. PeerJ 2023; 11:e15434. [PMID: 37426412 PMCID: PMC10324596 DOI: 10.7717/peerj.15434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/26/2023] [Indexed: 07/11/2023] Open
Abstract
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.
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Affiliation(s)
- Aya M. Haiba
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Marwan M. Haiba
- Faculty of Medicine, University of Ibn Sina, Khartoum, Sudan
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Lee M, Song Y, You M, Park SY, Ihm J. Dentists' attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea. BMC Oral Health 2023; 23:75. [PMID: 36747198 PMCID: PMC9903426 DOI: 10.1186/s12903-023-02791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patient-centered care (PCC) has been one of medical practice's most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists' patient-centered attitudes and investigating their predictors. METHODS The Patient-Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy. RESULTS A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude. CONCLUSIONS Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform.
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Affiliation(s)
- Minjung Lee
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Youngha Song
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Preventive and Social Dentistry, Seoul National University, Seoul, South Korea
| | - Myoungsoon You
- grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Shin-Young Park
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Dental Education, Seoul National University, Seoul, South Korea ,grid.459982.b0000 0004 0647 7483Predoctoral Treatment Center, Seoul National University Dental Hospital, Seoul, South Korea
| | - Jungjoon Ihm
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea. .,Department of Dental Education, Seoul National University, Seoul, South Korea. .,Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, Korea.
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Yeom I, Kim K, Choi J, Yoo DM. Experiences and perspectives on patient-centered education of medical students in Korea. KOREAN JOURNAL OF MEDICAL EDUCATION 2022; 34:259-271. [PMID: 36464897 PMCID: PMC9726231 DOI: 10.3946/kjme.2022.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 08/29/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE This study analyzed the current status of and correlations between Korean medical students' experiences and perspectives surrounding patient-centered medical education (PCME). METHODS A structured PCME questionnaire composed of three categories, understanding patients within social and cultural contexts, understanding patients' individual health contexts through communication, and placement of patients at the center of medical education, was used. The students were stratified into pre-medical (Pre-med), medical (Med), and policlinic (PK) groups because of curriculum differences by grade. The χ2 test was applied to analyze the association between students' experiences with and perspectives on PCME. A Cramer's V of 0.200 was considered a large effect size for any association between experiences with and perspectives on PCME. RESULTS Among the respondents, 50.6% answered that they did not know about patient-centered medicine before the survey. With increasing school years went up from Pre-med to PK, fewer students agreed that PCME should be added to pre-clinical medicine curricula (p<0.001), that patients should be in the center throughout medical education (p=0.011), and that patients' personal histories, values, and objectives are important PCME (p=0.001). Students who said they learned PCME for each category were more likely to consider PCME important (Cramer's V was 0.219 and 0.271 for "with," and "for the patients" respectively, p<0.001 for "about/with/for the patients"). Students in all groups chose clinical practice as the best method for PCME (p=0.021). Med group chose the lectures as the most effective tool to learn about the importance of communication (p<0.001). CONCLUSION Students who experienced PCME were likely to perceive PCME as important and it showed that experiences of PCME had positive effects on PCME perceptions. Despite students' preferences for clinical practice as the best method for PCME, PK reported that they did not learn PCME, and regarded PCME as less important compared to students at earlier stages of their medical education. Therefore, more intensive and holistic PCME curricula rather than only clinical practice exposure may be necessary.
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Affiliation(s)
- Inji Yeom
- Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kiduk Kim
- Eulji University School of Medicine, Daejeon, Korea
| | - Junhwan Choi
- Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong-Mi Yoo
- Department of Medical Education, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Munger MA, Tak C, Henchey C, Dey S, Feehan M. Longitudinal analysis of PharmD program students' satisfaction and stress. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:959-965. [PMID: 36055704 DOI: 10.1016/j.cptl.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The University of Utah College of Pharmacy conducted an annual survey to gauge the relationship between multiple dimensions of students' satisfaction, and stress, with the doctor of pharmacy (PharmD) program and perceptions of future career plans. METHODS An online survey of professional year one (P1) through professional year four (P4) students was conducted from 2015 to 2019. RESULTS There were a total of 953 non-unique survey respondents. The overall response rate was 86.8%. The study population was 51% female and 49% male with a mean age of 26.7 ± 3.3 years. Students were moderately to very satisfied with the curriculum across the four years of the program. Students were highly to moderately likely to recommend the program. Likelihood to recommend the pharmacy career was similar for the P1 and second professional year 2 (P2) but declined over the four years. Students were moderately to neutrally affected by stress, highest in the P2 and third professional year. Financial issues were rated as the highest stress across the four years. Gender was not statistically associated with satisfaction, although women had higher stress impacting their health than men. Likelihood to recommend the PharmD program and pharmacy career was rated higher by younger students. CONCLUSIONS Student satisfaction with the PharmD program should be a priority since higher education is a service industry. Academic pharmacy should consider whether pedagogical and social mechanisms are in place to ensure that their programs are helping students manage stress and promote satisfaction.
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Affiliation(s)
- Mark A Munger
- University of Utah, 30 South, 2000 East, Rm #4958, Salt Lake City, UT 84112-5820, United States.
| | - Casey Tak
- University of Utah, 30 South, 2000 East, Rm #4958, Salt Lake City, UT 84112-5820, United States; Department of Pharmacotherapy, University of Utah, 30 South, 2000 East, Rm #4956, Salt Lake City, Utah 84112-5820, United States.
| | - Craig Henchey
- College of Pharmacy, University of Utah, 30 South, 2000 East, Rm #112, Salt Lake City, UT 84112-5820, United States.
| | - Surajit Dey
- Roseman University for Health Sciences, 11 Sunset Way, Henderson, NV, 89014, United States.
| | - Michael Feehan
- Health Division, 3 World Trade Center, 34th Floor, 175 Greenwich Street, New York, NY 10007-2438, United States; Cerner Enviza, North Kansas City, MO, United States; Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States.
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Bansal A, Greenley S, Mitchell C, Park S, Shearn K, Reeve J. Optimising planned medical education strategies to develop learners' person-centredness: A realist review. MEDICAL EDUCATION 2022; 56:489-503. [PMID: 34842290 PMCID: PMC9306905 DOI: 10.1111/medu.14707] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 05/31/2023]
Abstract
CONTEXT Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful. METHODS A realist review was conducted with a search of Medline, Embase, HMIC and ERIC databases and the grey literature using the terms 'medical education' and 'person-centred' and related synonyms. Studies that involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focused on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness. RESULTS Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome configuration (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focused on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness. CONCLUSION Our findings offer explanations as to why communication skills-based interventions may be insufficient to develop learners' person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policymakers testable theory to inform the development of medical education strategies that aim to support person-centredness.
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Affiliation(s)
- Aarti Bansal
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
| | - Sarah Greenley
- Institute of Clinical and Applied Health ResearchUniversity of HullHullUK
| | - Caroline Mitchell
- Academic Unit of Medical EducationSam Fox House, Northern General HospitalSheffieldUK
| | - Sophie Park
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Katie Shearn
- Health and Wellbeing Research Institute – Postgraduate Research CentreSheffield Hallam UniversitySheffieldUK
| | - Joanne Reeve
- Academy of Primary Care, Hull York Medical SchoolUniversity of HullHullUK
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Orrego C, Perestelo-Pérez L, González-González AI, Ballester-Santiago M, Koatz D, Pacheco-Huergo V, Rivero-Santana A, Ramos-García V, Fernández NM, Torres-Castaño A, Bermejo-Caja C. A Virtual Community of Practice to Improve Primary Health Care Professionals' Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial. Ann Fam Med 2022; 20:204-210. [PMID: 35606139 PMCID: PMC9199051 DOI: 10.1370/afm.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We aimed to evaluate the effectiveness of a virtual community of practice (vCoP) in improving primary health care professionals' (HCPs') attitudes toward empowering patients with chronic disease. METHODS We conducted a cluster randomized controlled trial. Practices were units of randomization, and primary HCPs and patients were units of analysis. Sixty-three practices in Madrid, Catalonia, and the Canary Islands were randomly allocated to the intervention or control groups. Randominzation of practices was performed after HCP and patient recruitment. The patients and statistician were anonymized to group allocation; it was not possible to anonymize HCPs. The intervention was a 12-month multicomponent tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was Patient-Provider Orientation Scale (PPOS) score at baseline and at 12 months. The secondary outcome was the Patient Activation Measure (PAM) score. RESULTS A total of 321 HCPs and 1,921 patients were assessed. The intervention had a positive effect on PPOS total score (0.14 points higher in the vCoP arm; 95% CI, 0.03-0.25; P = .011) and the PPOS Sharing subscale (0.3 points higher in the vCoP arm; 95% CI, 0.15-0.44; P < .001). No effect was found for the PPOS Caring subscale, and no significant differences were found for PAM scores. CONCLUSIONS A vCoP led to a minor increase in the PPOS Sharing component and the total score but not in the Caring component. However, considerable uncertainty remains, given the observed attrition and other limitations of the study. Further research is needed on the effectiveness of the vCoP model and on how to improve HCP engagement.VISUAL ABSTRACT.
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Affiliation(s)
- Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain .,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Lilisbeth Perestelo-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
| | - Ana Isabel González-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Institute of General Practice, Goethe University, Frankfurt, Germany.,Subdirección General de Investigación Sanitaria y Documentación, Dirección General Investigación, Docencia y Documentación, Consejería de Sanidad, Madrid, Spain
| | - Marta Ballester-Santiago
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Débora Koatz
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Valeria Pacheco-Huergo
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Centro de Atención Primaria Turó, Instituto Catalán de la Salud, Barcelona, Spain
| | - Amado Rivero-Santana
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Nuria Mora Fernández
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carlos Bermejo-Caja
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Unidad de Apoyo Técnico, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
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11
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Zuchelkowski BE, Eljamri S, McDonnell JE, Varma B, Stern NG, Rothenberger SD, Arora KS, Chang JC. Medical Student Attitudes on Explicit Informed Consent for Pelvic Exams Under Anesthesia. JOURNAL OF SURGICAL EDUCATION 2022; 79:676-685. [PMID: 35058165 PMCID: PMC9064935 DOI: 10.1016/j.jsurg.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To obtain an overview of medical student attitudes on the need for explicit consent for pelvic exams under anesthesia performed for educational purposes DESIGN: From February to October 2020, 201 medical students at a single medical school in the United States participated in a cross-sectional survey after completion of the obstetrics and gynecology clerkship. Outcome measures included endorsement of need for explicit informed consent for educational pelvic exams under anesthesia, and knowledge of informed consent processes for such exams. SETTING University of Pittsburgh School of Medicine PARTICIPANTS: Third- and fourth-year medical students RESULTS: Overall, 75% of medical students endorsed a need for explicit informed consent for educational pelvic exams under anesthesia, which extended to prostate, rectal, and breast exams under anesthesia. Additionally, 45% and 77% of these participants indicated that consent for educational pelvic exams under anesthesia should take the form of a separate signature line on the surgical consent form and/or a verbal form, respectively. Only 40% of students correctly identified institutional policy for obtaining informed consent for educational pelvic exams under anesthesia. Rotation with the oncologic surgical service (p = 0.02) and correct identification of institutional informed consent policies (p = 0.002) were associated with decreased perceptions of the importance of explicit informed consent for educational pelvic exams under anesthesia. CONCLUSIONS Medical students at the institution studied largely support explicit informed consent for educational pelvic and other sensitive exams under anesthesia, but a knowledge gap on institutional informed consent policy exists. Medical students support increased transparency and bodily autonomy. Due to the agreement of patients and medical students and the ethical rationale for this position, it may be appropriate for physicians and institutions to consider new processes of obtaining explicit informed consent for pelvic exams under anesthesia by medical students.
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Affiliation(s)
- Benjamin E Zuchelkowski
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Soukaina Eljamri
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jill E McDonnell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bhavya Varma
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Natalie G Stern
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kavita Shah Arora
- Department of Ob/Gyn, University of North Carolina, Chapel Hill, North Carolina
| | - Judy C Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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12
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Bejarano G, Csiernik B, Young JJ, Stuber K, Zadro JR. Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis. BMC MEDICAL EDUCATION 2022; 22:324. [PMID: 35477455 PMCID: PMC9047330 DOI: 10.1186/s12909-022-03371-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Geronimo Bejarano
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth), 1616 Guadalupe Street, Austin, TX, 78702, USA.
| | - Ben Csiernik
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - James J Young
- Canadian Memorial Chiropractic College, Toronto, Canada
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Kent Stuber
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Joshua R Zadro
- Sydney School of Public Health, Faculty of Medicine and Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
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13
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Bányai G, Dombrádi V, Katona C, Boruzs K, Dezső G, Nagy A, Bíró K. Preference for patient-centered communication among the citizens of the Visegrad countries. PATIENT EDUCATION AND COUNSELING 2021; 104:3086-3092. [PMID: 33958254 DOI: 10.1016/j.pec.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Cintia Katona
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gréta Dezső
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
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14
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Ruiz-Moral R, Monge Martin D, Garcia de Leonardo C, Denizon S, Cerro Pérez A, Caballero Martínez F. Medical students' attitudes towards communication skills training: a longitudinal study with one cohort. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc107. [PMID: 34651065 PMCID: PMC8493848 DOI: 10.3205/zma001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
Objectives: To explore medical students' attitudes towards communication skills and the evolution of these attitudes from their first to fourth academic years. Methods: A cohort of 91 medical students completed the Communication Skills Attitudes Scale (CSAS) at the beginning of their medical studies and at the end of their fourth year after having engaged in a training program in communication skills with experiential characteristics (individual encounters with simulated patients, observations in small groups, feedback, and practice). We analyzed students' positive and negative global attitudes and their affective, cognitive, and respect dimensions towards learning communication skills. Results: Medical students' attitudes toward communication skills declined from their first (52.8) to fourth year (49.6) (p=.011). Along with this significant decrease in positive attitudes, a significant increase in negative attitudes toward communication skills was also observed in trained students (32.2 vs. 34.2; p=.023). The decline in students' attitudes mainly involves a decline in their affective (51.4 vs. 47.3, p=.001) but not cognitive (18.3) attitudes. Female students have more positive attitudes towards communication skills than male students. Conclusions: The decline in students' attitudes, mainly in the affective dimension, could be related to their accumulated learning experiences during the learning process and particularly their experiential training in communication skills. Nevertheless, the importance students give to communication skills in the cognitive dimension remains unchanged. Students' gender also seems to influence their attitudes. Further research is needed to assess the role of other factors involved in this decrease in positive and affective attitudes.
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Affiliation(s)
- Roger Ruiz-Moral
- Universidad Francisco de Vitoria, Facultad de Ciencias de la Salud, Escuela de Medicina, Departamento de Educación Médica, Madrid, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Diana Monge Martin
- Universidad Francisco de Vitoria, Facultad de Ciencias de la Salud, Medicina Familiar y Preventiva, Madrid, Spain
| | | | - Sophia Denizon
- Universidad Francisco de Vitoria, Facultad de Ciencias de la Salud, Escuela de Medicina, Madrid, Spain
| | - Alvaro Cerro Pérez
- Universidad Francisco de Vitoria, Escuela de Ciencias de la Salud, Madrid, Spain
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15
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Björklund K, Stenfors T, Nilsson GH, Alinaghizadeh H, Leanderson C. Let's ask the patient - composition and validation of a questionnaire for patients' feedback to medical students. BMC MEDICAL EDUCATION 2021; 21:269. [PMID: 33971866 PMCID: PMC8111976 DOI: 10.1186/s12909-021-02683-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 04/22/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Adequate communication and maintaining a patient-centered approach throughout patient encounters are important skills for medical students to develop. Feedback is often provided by clinical teachers. Patients are seldom asked to provide feedback to students that systematically addresses knowledge and skills regarding communication and patient-centeredness during an encounter. One way for patients to provide feedback to students is through a questionnaire; there is, however, a lack of such validated feedback questionnaires. This study aimed to compose and validate a feedback questionnaire for patients' feedback to medical students regarding students' ability to communicate and apply patient-centeredness in clinical practice. METHOD This study comprises (a) composition of the questionnaire and (b) validation of the questionnaire. The composition included (1) literature review, (2) selection and composition of items and construction of an item pool, (3) test of items' content, and (4) test of the applicability of the questionnaire. The items originated from the Calgary-Cambridge Guide (Kurtz S, Silverman J, Benson J and Draper J, Acad Med 78:802-809, 2003), the 'Swedish National Patient Survey' (National Patient Survey, Primary Health Care, 2020), patient evaluation form by Braend et al. (Tidsskr Nor Laegeforen 126:2122-5, 2006), and additional developed items. The items were further developed after feedback from 65 patients, 22 students, eight clinical supervisors, and six clinical teachers. The validation process included 246 patients who provided feedback to 80 students. Qualitative content analysis and psychometric methods were used and exploratory factor analysis assessed internal validity. Cronbach's alpha was used to test the reliability of the items. RESULTS The process resulted in the 19-item 'Patient Feedback in Clinical Practice' (PFCP) questionnaire. Construct validity revealed two dimensions: consultational approach and transfer of information. Internal consistency was high. Thematic analysis resulted in three themes: ability to capture the personal agenda of the consultation, alignment with the consultation, and constructs and characteristics. Students reported that the PFCP questionnaire provided useful feedback that could facilitate their learning in clinical practice. CONCLUSIONS The results of this study indicate that the questionnaire is a valid, reliable, and internally consistent instrument for patients' feedback to medical students. The participants found the questionnaire to be useful for the provision of feedback in clinical practice. However, further studies are required regarding the PFCP questionnaire applicability as a feedback tool in workplace learning.
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Affiliation(s)
- Karin Björklund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar H Nilsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | | | - Charlotte Leanderson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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16
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Lee M, Ihm J. Empathy and attitude toward communication skill learning as a predictor of patient-centered attitude: a cross-sectional study of dental students in Korea. BMC MEDICAL EDUCATION 2021; 21:225. [PMID: 33882935 PMCID: PMC8058758 DOI: 10.1186/s12909-021-02674-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Minjung Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jungjoon Ihm
- Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea.
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea.
- Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, South Korea.
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17
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Ardenghi S, Rampoldi G, Pepe A, Bani M, Salvarani V, Strepparava MG. An Exploratory Cross-Sectional Study on the Relationship between Dispositional Mindfulness and Empathy in Undergraduate Medical Students. TEACHING AND LEARNING IN MEDICINE 2021; 33:154-163. [PMID: 32870715 DOI: 10.1080/10401334.2020.1813582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a growing interest in identifying the psychological variables that promote and sustain empathy in medical students during their studies. Dispositional mindfulness has been shown to be empirically associated with socio-demographic characteristics and empathy among the general population. This research aimed to assess dispositional mindfulness in a sample of undergraduate medical students and to investigate its association with gender, age, and empathy. Hypotheses: It is hypothesized that male medical students would show, on average, higher dispositional mindfulness than their female counterparts, and that older students would exhibit higher dispositional mindfulness than younger ones. Dispositional mindfulness was also expected to be positively associated with the ability to feel compassion for others and to adopt their perspective, and negatively associated with the personal distress in tense interpersonal settings. Method: An exploratory cross-sectional study was conducted. Data were gathered from a large sample (N = 933) of Italian non-meditating second- and fifth-year medical students. Dispositional mindfulness and empathy were assessed using the Five-Facet Mindfulness Questionnaire and the Interpersonal Reactivity Index, respectively. Gender and age differences in dispositional mindfulness scores were calculated by analyses of variance, whereas hierarchical multiple regression models were used to assess the association between dispositional mindfulness and empathy scores. RESULTS Female medical students were more able to Act with Awareness than males, whereas males had higher levels than females of Describing and Nonreactivity to their feelings. When compared to their older counterparts, younger students scored higher on Observing and lower on Nonreactivity facets. Dispositional mindfulness facets correlated differently with both emotional and cognitive empathy dimensions, beyond the effects of gender and age. Medical students who displayed higher dispositional mindfulness appeared to be less emotionally distressed in tense interpersonal settings and more able to take others' cognitive perspective. Conclusions: The findings support the notion that dispositional mindfulness is related to empathy and may have implications for the design of mindfulness-based training for use in the medical educational setting. Tailored interventions that cultivate specific dispositional mindfulness facets may be implemented along the medical curriculum to prevent the emotional distress in tense interpersonal settings and to sustain the cognitive capability to take others' viewpoints among medical students.
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Affiliation(s)
- Stefano Ardenghi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza and Brianza, Italy
| | - Giulia Rampoldi
- Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Milan, Italy
| | - Alessandro Pepe
- Department of Human Sciences for Education, University of Milano-Bicocca, Milano, Milan, Italy
| | - Marco Bani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza and Brianza, Italy
| | - Valerio Salvarani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza and Brianza, Italy
| | - Maria Grazia Strepparava
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza and Brianza, Italy
- Clinical Psychology Unit, San Gerardo Hospital, ASST-Monza, Monza, Monza and Brianza, Italy
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18
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Cantaert GR, Van Hecke A, Smolderen K. Perceptions of physicians, medical and nursing students concerning shared decision-making: a cross-sectional study. Acta Clin Belg 2021; 76:1-9. [PMID: 31272338 DOI: 10.1080/17843286.2019.1637487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The purpose of this study was to evaluate the attitudes of Flemish physicians and medical/nursing trainees regarding shared decision-making (SDM) and to determine possible differences based on sex, age, rank, occupation and specialty. Methods: A cross-sectional study was conducted between June and September 2017 in which the Patient-Practitioner Orientation Scale (PPOS) was translated and administered. Higher scores on the six-point scale indicate a patient-centered respondent. Independent t-tests, One and Two-way ANOVA and multivariate regression analysis with the variables sex, age, occupation and specialty were performed. Results: 266 responses from 93 physicians, 147 medical and 26 nursing students were analyzed. Mean sharing scores were 4,24 ± 0,64; 4,30 ± 0,61; and 4,30 ± 0,67, respectively. In the regression model, female sex (p < 0,10) and employment (p < 0,05) in general practice or internal medicine is predictive for higher sharing among physicians. Bivariate analysis revealed significant differences between specialisms (p < 0,05): pediatricians (4,79 ± 0,69), psychiatrists (4,74 ± 0,47), obstetricians/gynecologists (4,40 ± 0,38) and general practitioners (4,31 ± 0,59) scored higher on the PPOS than surgeons (3,84 ± 0,58). Conclusion: Flemish providers and trainees are disease-centered. Physicians' attitudes vary depending on their specialism, presumably due to prolonged exposure to the specific clinical context. Additionally, academic-trained nurses share the belief that the physician should decide and the patient should rely on his knowledge rather than his own. There is an urgent need for health policy and educational institutions to facilitate an environment in which SDM is supported.
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Affiliation(s)
- Gabriël Rafaël Cantaert
- Department of Public Health and primary care, University Centre for Nursing & Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and primary care, University Centre for Nursing & Midwifery, Ghent University, Ghent, Belgium
- Staff director of Nursing, Nursing Departement, Ghent University Hospital, Ghent, Belgium
| | - Kim Smolderen
- Department of Biomedical & Health Informatics, University of Missouri-Kansas City, Missouri-Kansas, KS, USA
- Saint Luke's Mid America Heart Institute, Missouri-Kansas, KS, USA
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19
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Perestelo-Pérez L, Rivero-Santana A, González-González AI, Bermejo-Caja CJ, Ramos-García V, Koatz D, Torres-Castaño A, Ballester M, Muñoz-Balsa M, Del Rey-Granado Y, Pérez-Rivas FJ, Canellas-Criado Y, Ramírez-Puerta AB, Pacheco-Huergo V, Orrego C. Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain. Health Expect 2020; 24:33-41. [PMID: 33124759 PMCID: PMC7879539 DOI: 10.1111/hex.13135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/18/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain. METHODS Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). RESULTS Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. CONCLUSION Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information.
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Affiliation(s)
- Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Centre for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain
| | - Amado Rivero-Santana
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Centre for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Ana Isabel González-González
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Primary Care Centre Vicente Muzas, Community of Madrid Health Service, Madrid, Spain.,Institute of General Medicine, Johann Wolfgang Goethe University, Frankfurt-am-Main, Germany
| | - Carlos Jesús Bermejo-Caja
- Support Unit for Primary Care, Community of Madrid Health Service, Madrid, Spain.,Nursing Department, Autonomus University of Madrid, Madrid, Spain
| | - Vanesa Ramos-García
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Débora Koatz
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Alezandra Torres-Castaño
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Canary Islands Foundation and Institute for Health Research (FIISC), Tenerife, Spain
| | - Marta Ballester
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Carola Orrego
- Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.,Avedis Donabedian Institute, Autonomous University of Barcelona, Barcelona, Spain
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20
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Colonnello V, Mattarozzi K, Agostini A, Russo PM. Emotionally salient patient information enhances the educational value of surgical videos. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:799-808. [PMID: 31960188 DOI: 10.1007/s10459-020-09957-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Medical students' motivations for choosing a medical career are likely based on and remain tethered to the affectively-laden caring component of doctor-patient interactions. However, this component is rarely presented in educational surgical videos. It is unknown whether affectively engaging students by including patient-related emotionally salient information potentiates or draws focus away from learning a surgical procedure and whether such information affects motivation and attitudes toward the video. Therefore, we investigate whether presenting a patient's emotional state before video surgery enhances or weakens the educational value of that video. In a within-subjects crossover design, second-year medical students (n = 130) viewed video clips of surgeries. These videos, from online medical education platforms, were preceded by the patient's information from the original video or by information about the patient's preoperative emotional preparation. After each video, participants completed a multiple-choice test about the video's content to measure learning, answered a question about their motivation to re-watch the video, and completed an attitude scale regarding the video. Incorporating patient's information into surgical videos significantly enhanced students' acquisition of the technical aspects of surgery procedures (p < 0.0001), motivation to re-watch the video (p < 0.001), and favorable attitudes toward the video (p = 0.02). These findings show that incorporating information about patients' emotional states may enhance students' positive attitudes and motivations toward educational videos and may improve their learning of surgical techniques. They also suggest that the role of this factor should be considered when developing guidelines for medical educational video release.
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Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40127, Bologna, Italy.
| | - Katia Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40127, Bologna, Italy
| | - Alessandro Agostini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40127, Bologna, Italy
| | - Paolo Maria Russo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40127, Bologna, Italy
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Moyo M, Shulruf B, Weller J, Goodyear-Smith F. Effect of medical students' values on their clinical decision-making. J Prim Health Care 2020; 11:64-74. [PMID: 31039991 DOI: 10.1071/hc18055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Personal and professional values of health-care practitioners influence their clinical decisions. AIM To investigate how medical students' values influence their clinical decisions. METHODS Values of 117 medical students were measured using an instrument we developed, the Healthcare Practitioner Values Scale. Factors that students consider in clinical decision-making were identified in four clinical scenarios using qualitative coding. Differences in values between students who considered given factors in decision-making and students who did not consider the same factors were analysed. Random effects models were used to investigate which differences were explained by variation in the clinical scenarios and factors considered in decision-making. RESULTS Six factors that students consider in clinical decision-making were identified and grouped into three categories: patient-centred (patient perspective, family and social circumstances); clinical (patient safety, symptoms and treatment efficacy); and situational factors (health-care practitioner self-awareness and service cost). Students who prioritised spirituality placed more emphasis on patient-centred factors, and less emphasis on clinical factors in different scenarios; students who prioritised critical thinking placed less emphasis on patient-centred factors; and students who prioritised capability, professionalism and safety values placed more emphasis on situational factors. Total proportion of variance in value differences explained by factors and clinical scenarios was 25.2% for spirituality and 56.2% for critical thinking. DISCUSSION Students who prioritise different values consider different factors in their clinical decisions. Spirituality and critical thinking values are more likely to influence students' decision-making approaches than other values. Improving students' awareness of how their own values influence their decisions can help them improve their clinical decision-making.
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Affiliation(s)
- Mpatisi Moyo
- University of Auckland, Department of General Practice and Primary Health Care, Auckland, New Zealand; and Corresponding author.
| | - Boaz Shulruf
- University of New South Wales, Medical Education, Sydney, Australia
| | - Jennifer Weller
- University of Auckland, Centre for Medical and Health Science Education, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- University of Auckland, Department of General Practice and Primary Health Care, Auckland, New Zealand
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Harris M, Camenzind AL, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:217. [PMID: 32652987 PMCID: PMC7353797 DOI: 10.1186/s12909-020-02136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND While patient-centred care improves patient outcomes, studies have shown that medical students become less patient-centred with time, so it is crucial to devise interventions that prevent this. We sought to determine whether first-year medical students who had a structured home-based interview with a chronically ill patient became more patient-centred than those who had a sham intervention. METHODS This randomised controlled trial assigned first-year students from the University of Bern, Switzerland, to either an interview with a chronically ill patient at the patient's home or to a sham comparator. We used the PPOS-D12 questionnaire to measure students' levels of patient-centredness at baseline, and changes in these levels during their longitudinal primary care clerkship. RESULTS A total of 317 students participated. Patient-centred attitudes increased during the study. A home-based interview with a chronically ill patient had no additional effect. Being female and having been exposed to patients before medical school were associated with being more patient-centred at baseline. Students were less patient-centred than their General Practitioner teachers. CONCLUSIONS A structured, home-based interview with a chronically ill patient did not change students' patient-centred attitudes, so cannot be recommended as a way to influence those attitudes. However, patient-centred attitudes increased during the students' first year of study, possibly because of their longitudinal primary care clerkship. TRIAL REGISTRATION Clinicaltrials.gov reference: NCT03722810 , registered 29th October 2018.
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Affiliation(s)
- Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
- Gore Cottage, Emborough, Radstock, BA3 4SJ UK
| | - Anna-Lea Camenzind
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita Fankhauser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Drivenes K, Haaland VØ, Mesel T, Tanum L. Practitioners' positive attitudes promote shared decision-making in mental health care. J Eval Clin Pract 2019; 25:1041-1049. [PMID: 31508872 DOI: 10.1111/jep.13275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/05/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE AND AIMS There is a growing expectation of implementing shared decision making (SDM) in today's health care service, including mental health care. Traditional understanding of SDM may be too narrow to capture the complexity of treatments of mental health problems. Although the patients' contribution to SDM is well described, the contribution from the health care practitioners is less explored. Therefore, our aim was to explore the attitudes of practitioners in mental health care and the associations between practitioners' attitudes and SDM. METHOD We performed a cross-sectional study where practitioners reported their sharing and caring attitudes on the Patient-Practitioner Orientation Scale (PPOS) and age, gender, profession, and clinical working site. The patients reported SDM using the CollaboRate tool. We used a mixed effect model linking the data from each practitioner to one or more patients. We presented the findings and used them as background for a more philosophic reflection. RESULTS We included 312 practitioners with mean age 46.1 years. Of the practitioners, 60 held a medical doctors degree, 97 were psychologists, and 127 held a college degree in nursing, social science, or pedagogy. Female practitioners reported higher sharing (4.79 vs 4.67 [range 1-6], P = .04) and caring scores (4.77 vs 4.65 [range 1-6], P = .02) than males. The regression model contained 206 practitioners and 772 patients. We found a higher probability for the patient to report high SDM score if the practitioner reported higher sharing scores, and lower probability if the practitioner worked in ambulatory care. CONCLUSIONS SDM in mental health care is complex and demands multifaceted preparations from practitioners as well as patients. The practitioners' attitudes are not sufficiently explored using one instrument. The positive association between practitioners' patient-centred attitudes and SDM found in this study implies a relevance of the practitioners' attitudes for accomplishment of SDM processes in mental health care.
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Affiliation(s)
- Karin Drivenes
- Division of Mental Health, Sørlandet Hospital HF, Norway.,South Eastern Norway Hospital Pharmacy Enterprise, Kristiansand, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vegard Øksendal Haaland
- Division of Mental Health, Sørlandet Hospital HF, Norway.,Department of Psychology, Clinical Neuroscience Research Group, University of Oslo, Oslo, Norway
| | - Terje Mesel
- Division of Mental Health, Sørlandet Hospital HF, Norway.,Department of Religion Philosophy and History, University of Agder, Kristiansand, Norway
| | - Lars Tanum
- Research and Development Department Mental Health, Akershus University Hospital, Lorenskog, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Yen RW, Barr PJ, Cochran N, Aarts JW, Légaré F, Reed M, O'Malley AJ, Scalia P, Painchaud Guérard G, Backer G, Reilly C, Elwyn G, Durand MA. Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey. MDM Policy Pract 2019; 4:2381468319885871. [PMID: 31742232 PMCID: PMC6843737 DOI: 10.1177/2381468319885871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Nan Cochran
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Johanna W Aarts
- Department of Obstetrics & Gynecology, Radboudumc University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Université Laval, Department of Family Medicine, Quebec City, Quebec, Canada
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Geneviève Painchaud Guérard
- CHU de Quebec Research Center Université Laval, Saint-François d'Assise Hospital, Quebec City, Quebec, Canada
| | - Grant Backer
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Clifford Reilly
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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Michael K, Dror MG, Karnieli-Miller O. Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. PATIENT EDUCATION AND COUNSELING 2019; 102:2031-2037. [PMID: 31257098 DOI: 10.1016/j.pec.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
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Affiliation(s)
- Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel.
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Tak C, Henchey C, Feehan M, Munger MA. Modeling Doctor of Pharmacy Students' Stress, Satisfaction, and Professionalism Over Time. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7432. [PMID: 31871360 PMCID: PMC6920634 DOI: 10.5688/ajpe7432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/05/2019] [Indexed: 05/22/2023]
Abstract
Objective. To gauge multiple dimensions of pharmacy students' professionalism, stress, and satisfaction with the Doctor of Pharmacy (PharmD) program. Methods. An online survey of first- through fourth-year pharmacy students was conducted from 2015-2018 to gauge the degree of students' professionalism (personal reflection, patient-centric care focus, cultural and interprofessional competencies), program stress (levels, sources, and burnout syndrome), and satisfaction. Multilevel structural equation modeling (SEM) determined the relationship between stress and satisfaction, and the degree to which these impacted levels of professionalism after adjusting for potential correlates (age, sex, financial stress, relationship status, race, and employment status). Results. Seven hundred sixty-four responses to the survey were received across the four calendar years. Of the students in the sample, 51% were female with a mean (SD) age of 26.6 (3.4) years. The overall response rate to the surveys was 86.2%. Professionalism was most strongly indicated by the measures of community-centeredness, patient-centeredness, and perceived benefits of being part of a team-based environment. The SEM model demonstrated an inverse relationship between the two composite latent constructs of stress and satisfaction. When modeled simultaneously, program satisfaction was found to be the more significant predictor of professionalism than stress after adjusting for associations with age, sex, and relationship status. Conclusion. Professionalism of pharmacy students is positively associated with students' satisfaction with the program, but professionalism is not independently significantly predicted by stress. Students who have positive responses to community- and patient-centeredness and who feel they benefit from engaging in a team-based environment are most likely to have greater professionalism.
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Affiliation(s)
- Casey Tak
- University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Craig Henchey
- University of Utah College of Pharmacy, Salt Lake City, Utah
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Mohamed KG, Hunskaar S, Abdelrahman SH, Malik EM. Impact on core values of family medicine from a 2-year Master's programme in Gezira, Sudan: observational study. BMC FAMILY PRACTICE 2019; 20:145. [PMID: 31660866 PMCID: PMC6816210 DOI: 10.1186/s12875-019-1037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/17/2019] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Khalid Gaffer Mohamed
- Department of Family and Community Medicine, Faculty of Medicine Medina, University of Taibah, Medina, Saudi Arabia
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Family and Community Medicine, University of Gezira, Medani, Sudan
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Elfatih Mohamed Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, Lemeunier N, Maiers M, McCarthy P, Morales V, Myburgh C, Petrini V, Pohlman K, Mior S. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey. Chiropr Man Therap 2019; 27:46. [PMID: 31528334 PMCID: PMC6739992 DOI: 10.1186/s12998-019-0263-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Karin Hammerich
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Kent Stuber
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Sheilah Hogg-Johnson
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Anser Abbas
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Martin Harris
- 2Central Queensland University, Rockhampton, Australia
| | | | | | - Michele Maiers
- 5Northwestern Health Sciences University, Bloomington, USA
| | | | | | | | - Vanessa Petrini
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | | | - Silvano Mior
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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Rosewilliam S, Indramohan V, Breakwell R, Liew BXW, Skelton J. Patient-centred orientation of students from different healthcare disciplines, their understanding of the concept and factors influencing their development as patient-centred professionals: a mixed methods study. BMC MEDICAL EDUCATION 2019; 19:347. [PMID: 31510999 PMCID: PMC6737623 DOI: 10.1186/s12909-019-1787-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND A patient-centred approach to care is increasingly the mandate for healthcare delivery. There is a need to explore how health professional students develop patient-centred attributes. This study aims to understand the extent of patient-centred orientations of health professional students, their perceptions and factors influencing their adoption of the approach. METHODS The study used a cross-sectional, parallel mixed methods design combining a survey using the Patient-Practitioner Orientation Scale (PPOS) followed by focus groups with medical, nursing, physiotherapy and speech and language therapy students. Data included students' age, gender, programme, and placements experienced. Pearson's chi squared and the non-parametric equivalent Kruskal-Wallis H test were done to test for differences in demographics for appropriate variables. One-way ANOVA or Welch test was done to explore differences in PPOS scores. Regression analysis was done to test the influence of the demographic variables on PPOS scores. Data from focus groups were coded, categorised and organised under themes appropriate to the research aims. RESULTS Of the 211 complete responses, significant differences were observed between medical and physiotherapy students in total PPOS scores, (MD -8.11 [95% CI -12.02 - 4.20] p = 0.000), Caring component (MD -4.44 [95% CI - 6.69, - 2.19] p = 0.000) and Sharing component (MD -3.67 [95% CI -6.12 -1.22] p = 0.001). The programme in which students were enrolled i.e. Medicine and SALT were the only indicators of higher PPOS total scores (F = 4.6 Df 10,69; p = 7.396e-06) and caring scores (F = 2.164 Df 10, 69 p = 0.022). Focus groups revealed that students perceived patient-centredness as holistic yet individualised care through establishing a partnership with patient. They identified that their student status, placement pressures, placement characteristics especially mentoring influenced their development of patient-centred attributes. CONCLUSION This study highlights the fact that the pressures of training in the National Health Service affects the development of students' patient-centred orientation. There is a need for further work to explore aspects related to mentor training, for the development of patient-centred attributes, in a curricular framework structured on students' needs from this study.
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Affiliation(s)
- Sheeba Rosewilliam
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, Birmingham, UK.
| | - Vivek Indramohan
- Department of Life Sciences, School of Health Sciences, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | - Bernard Xian Wei Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - John Skelton
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Logan AC, Prescott SL, Katz DL. Golden Age of Medicine 2.0: Lifestyle Medicine and Planetary Health Prioritized. J Lifestyle Med 2019; 9:75-91. [PMID: 31828026 PMCID: PMC6894443 DOI: 10.15280/jlm.2019.9.2.75] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022] Open
Abstract
The 'golden age of medicine' - the first half of the 20th century, reaching its zenith with Jonas Salk's 1955 polio vaccine - was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive 'personal responsibility' view of health - blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine - including authoritarianism and social dominance orientation - are maintaining an unhealthy status quo.
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Affiliation(s)
- Alan C Logan
- in-VIVO Planetary Health, West New York, NJ, USA
| | - Susan L Prescott
- in-VIVO Planetary Health, West New York, NJ, USA.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - David L Katz
- Yale University, Prevention Research Center, Griffin Hospital, Derby, CT, USA
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Fothan AM, Eshaq AM, Bakather AM. Medical Students' Perceptions of the Doctor-Patient Relationship: A Cross-Sectional Study from Saudi Arabia. Cureus 2019; 11:e5053. [PMID: 31511805 PMCID: PMC6716967 DOI: 10.7759/cureus.5053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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).
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Affiliation(s)
- Ahmed M Fothan
- General Surgery, Trauma & Orthopaedics, College of Medicine, Alfaisal University, Riyadh, SAU
| | - Abdulaziz M Eshaq
- Internal Medicine, College of Medicine, Alfaisal University, Riyadh, SAU
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Prescott SL, Logan AC. Planetary Health: From the Wellspring of Holistic Medicine to Personal and Public Health Imperative. Explore (NY) 2019; 15:98-106. [DOI: 10.1016/j.explore.2018.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/29/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
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Prescott SL, Logan AC, Katz DL. Preventive Medicine for Person, Place, and Planet: Revisiting the Concept of High-Level Wellness in the Planetary Health Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020238. [PMID: 30654442 PMCID: PMC6352196 DOI: 10.3390/ijerph16020238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/29/2022]
Abstract
Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the ‘waiting room’ and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health—denoting the interconnections between the health of person and place at all scales—emerged from the environmental and preventive health movements of the 1970–1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse. Here, we discuss the relevance of planetary health in the era of personalized medicine, gross environmental concerns, and a crisis of non-communicable diseases. We frame our discourse around high-level wellness—a concept of vitality defined by Halbert L. Dunn (1896–1975); high-level wellness was defined as an integrated method of functioning which is oriented toward maximizing the potential of individuals within the total lived environment. Dunn maintained that high-level wellness is also applicable to organizations, communities, nations, and humankind as a whole—stating further that global high-level wellness is a product of the vitality and sustainability of the Earth’s natural systems. He called for a universal philosophy of living. Researchers and healthcare providers who focus on lifestyle and environmental aspects of health—and understand barriers such as authoritarianism and social dominance orientation—are fundamental to maintaining trans-generational vitality at scales of person, place, and planet.
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Affiliation(s)
- Susan L Prescott
- Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA 6009, Australia.
- The ORIGINS Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia.
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - Alan C Logan
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - David L Katz
- Prevention Research Center, Yale University School of Public Health, Griffin Hospital, Derby, CT 06418, USA.
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Henschen BL, Ryan ER, Evans DB, Truong A, Wayne DB, Bierman JA, Cameron KA. Perceptions of Patient-Centered Care among First-Year Medical Students. TEACHING AND LEARNING IN MEDICINE 2019; 31:26-33. [PMID: 29847155 DOI: 10.1080/10401334.2018.1468260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: Teaching patient-centered care (PCC) is a key component of undergraduate medical curricula. Prior frameworks of PCC describe multiple domains of patient-centeredness, ranging from interpersonal encounters to systems-level issues. Medical students' perceptions of PCC are thought to erode as they progress through school, but little is known about how students view PCC toward the beginning of training. This study explores the perceptions of PCC among 1st-year medical students to inform curricular development and evaluation. Approach: Medical students participated in semistructured, in-person interviews within 4 months of starting medical school as part of a longitudinal study. Transcripts were analyzed using a grounded theory approach and the constant comparative method to describe responses and characterize emergent themes. Transcripts were reviewed to compare codes and compile a final codebook. Findings: Thirty-eight students completed interviews. Students provided heterogeneous definitions of PCC, including perceptions that PCC is implicit and obvious. Many students were unable to provide a concrete definition of PCC, juxtaposing PCC with other priorities such as profit- or physician-centered care, whereas others thought the term was jargon. Some participants defined PCC as upholding patient values using hypothetical examples centered around physician behavior. Insights: Although students appeared to enter medical school with a range of perceptions about PCC, many of their descriptions were limited and only scratch the surface of existing frameworks. Rather than their perceptions of PCC eroding during medical school, students may never fully develop a foundational understanding of PCC. Our findings reinforce the need for authentic, clinically experiential learning opportunities that promote PCC from the earliest stages of medical education.
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Affiliation(s)
- Bruce L Henschen
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth R Ryan
- b Department of Family and Community Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Daniel B Evans
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Ashley Truong
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Diane B Wayne
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Jennifer A Bierman
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Kenzie A Cameron
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Harada ND, Rajashekara S, Sansgiry S, Wirtz Rugen K, King S, Gilman SC, Davila JA. Developing Interprofessional Primary Care Teams: Alumni Evaluation of the Department of Veterans Affairs Centers of Excellence in Primary Care Education Program. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519875455. [PMID: 35187259 PMCID: PMC8855379 DOI: 10.1177/2382120519875455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/15/2019] [Indexed: 06/14/2023]
Abstract
PURPOSE The Centers of Excellence in Primary Care Education (CoEPCE) is an interprofessional graduate training program within the Department of Veterans Affairs (VA). In this project, we describe career paths of CoEPCE graduates, their perceptions of CoEPCE program value, their overall satisfaction with the training, and suggestions for program improvement to enhance interprofessional education and workforce development. METHODS The Graduate Participant Survey was developed and administered in 2018 to CoEPCE graduates from 2012 to 2017. Quantitative data from closed-ended questions were analyzed through descriptive and non-parametric statistics to test for significant differences by profession. Qualitative data from the single open-ended question were analyzed using content analysis with inductive and deductive approaches. RESULTS The survey was completed by 180 graduates. Greater proportions of pharmacists and psychologists than nurse practitioners and physicians were employed in VA, and greater proportions of nurse practitioners and pharmacists than physicians and psychologists were employed in primary care. Although smaller proportions of physicians were currently employed in primary care (P < .0001), a greater proportion completed advanced training programs (P < .0001). Overall, graduates perceived that their CoEPCE training was highly valued by advanced training programs and employers and improved their chances of finding a job. They reported high levels of satisfaction (mean = 4.3 ± 0.9 out of 5 total) with the training program, continued to use skills they learned during training, and believe their CoEPCE experiences made them better health care providers. CONCLUSIONS Ninety-four percent of the CoEPCE graduates were employed at the VA and/or primary care at the completion of their training, although there were significant differences by profession. Graduates continued to practice interprofessional skills learned during their training and were highly satisfied with the program. Taken together, the findings indicate that continued enhancements to the interprofessional clinical learning environment are warranted.
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Affiliation(s)
- Nancy D Harada
- Centers of Excellence in Primary Care Education, Office of Academic Affiliations, U.S. Department of Veterans Affairs, Washington, DC, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shruthi Rajashekara
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathryn Wirtz Rugen
- Centers of Excellence in Primary Care Education, Office of Academic Affiliations, U.S. Department of Veterans Affairs, Washington, DC, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Samuel King
- Centers of Excellence in Primary Care Education, Office of Academic Affiliations, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Stuart C Gilman
- Centers of Excellence in Primary Care Education, Office of Academic Affiliations, U.S. Department of Veterans Affairs, Washington, DC, USA
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Jessica A Davila
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Brouwers MH, Bor H, Laan R, van Weel C, van Weel-Baumgarten E. Students' experiences with a longitudinal skills training program on breaking bad news: A follow-up study. PATIENT EDUCATION AND COUNSELING 2018; 101:1639-1644. [PMID: 29779606 DOI: 10.1016/j.pec.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/15/2018] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) should be trained, preferably early and following a helical model with multiple sessions over time, including feedback on performance. It's unclear how medical students evaluate such an approach. METHODS We gathered student opinions regarding a helical BBN training programme, the feedback and emotional support they received, and the applicability of the skills training immediately after BBN skills training (Q1) and after finishing their clinical clerkships (Q2). RESULTS Students find a helical curriculum useful, but this declines on follow-up. At Q2 students report less satisfaction with the amount of feedback and emotional support they received and report that the skills training was less applicable in clinical practice compared to what they reported at Q1. CONCLUSION A helical BBN training programme with early exposure seems to lead to a shift from students being unconsciously incompetent to consciously incompetent. Students would have appreciated more emotional support and feedback. PRACTICE IMPLICATIONS We recommend more feedback and emotional support after BBN during clerkships. The gap between classroom and practice can be diminished by emphasizing real life role play and clinical role models should demonstrate continuity and agreement between the skills that are taught and those that are used in clinical practice.
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Affiliation(s)
- M H Brouwers
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - H Bor
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - R Laan
- Health Academy, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C van Weel
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia.
| | - E van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Rice K, Ryu JE, Whitehead C, Katz J, Webster F. Medical Trainees' Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:775-780. [PMID: 29140917 PMCID: PMC5929494 DOI: 10.1097/acm.0000000000002053] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Evidence suggests that physicians' opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. METHOD This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. RESULTS Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. CONCLUSIONS Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients.
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Affiliation(s)
- Kathleen Rice
- K. Rice is a postdoctoral fellow, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jae Eun Ryu
- J.E. Ryu is a medical student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Whitehead
- C. Whitehead is director and scientist, Wilson Centre, University Health Network, associate professor, Department of Family and Community Medicine, University of Toronto, vice president for education, Women’s College Hospital, and BMO Financial Group Chair, Health Professions Research, University Health Network, Toronto, Ontario, Canada
| | - Joel Katz
- J. Katz is professor and Canada Research Chair in Health Psychology, Department of Psychology, York University, Toronto, Ontario, Canada
| | - Fiona Webster
- F. Webster is associate professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, scientist, Wilson Centre, University Health Network, and academic fellow, Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
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Ishikawa H, Son D, Eto M, Kitamura K, Kiuchi T. Changes in patient-centered attitude and confidence in communicating with patients: a longitudinal study of resident physicians. BMC MEDICAL EDUCATION 2018; 18:20. [PMID: 29370796 PMCID: PMC5785873 DOI: 10.1186/s12909-018-1129-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/17/2018] [Indexed: 05/06/2023]
Abstract
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.
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Affiliation(s)
- Hirono Ishikawa
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Daisuke Son
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Masato Eto
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
- General Education Center, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Kiyoshi Kitamura
- School of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita-shi, Chiba, 286-8686 Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Hurley EA, Doumbia S, Kennedy CE, Winch PJ, Roter DL, Murray SM, Harvey SA. Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study. BMJ Open 2018; 8:e019224. [PMID: 29362266 PMCID: PMC5786142 DOI: 10.1136/bmjopen-2017-019224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/OBJECTIVE Patient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes towards patient-centredness and examine validity of the 18-item Patient-Practitioner Orientation Scale (PPOS) in this context. PARTICIPANTS/SETTING 430 medical students in years 1, 3, 5 and 6 of a 6-year medical training programme in Bamako, Mali. DESIGN We conducted a cross-sectional survey, compared the proportion of students who agreed with each PPOS item by gender and academic year, and calculated composite PPOS scores. To examine psychometrics of the PPOS and its two subscales ('sharing' and 'caring'), we calculated internal consistency (Cronbach's alpha) and performed confirmatory and exploratory factor analyses (CFA and EFA). RESULTS In seven of the nine 'sharing' items, the majority of students held attitudes favouring a provider-dominant style. For five of the nine 'caring' items, the majority of student responded consistently with patient-centred attitudes, while in the other four, responses indicated a disease-centred orientation. In eight items, a greater proportion of fifth/sixth year students held patient-centred attitudes as compared with first year students; there were few gender differences. Average PPOS scores indicated students were moderately patient-centred, with more favourable attitudes towards the 'caring' aspect than 'sharing'. Internal consistency of the PPOS was inadequate for the full scale (α=0.58) and subscales ('sharing' α=0.37; 'caring' α=0.48). CFA did not support the original PPOS factors and EFA did not identify an improved structure. CONCLUSIONS West African medical students training in Bamako are moderately patient-centred and do not show the same declines in patient-centred attitudes in higher academic years as seen in other settings. Medical students may benefit from training in shared power skills and in attending to patient lifestyle factors. Locally validated tools are needed to guide West African medical schools in fostering patient-centredness among students.
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Affiliation(s)
- Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seydou Doumbia
- Faculté de Medecine et d'OdontoStomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven A Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Grilo AM, Santos Rita J, Carolino ET, Gomes AI, dos Santos MC. Centração no paciente: Contributo para o estudo de adaptação da patient-practitioner orientation scale (PPOS). PSYCHOLOGY, COMMUNITY & HEALTH 2018. [DOI: 10.5964/pch.v6i1.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
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.
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Yakeley J, Shoenberg P, Morris R, Sturgeon D, Majid S. Psychodynamic approaches to teaching medical students about the doctor–patient relationship: randomised controlled trial. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.033704] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor–patient communication and the doctor–patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor–patient relationship administered at baseline, at 3 months and at 1 year.ResultsAt 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline.Clinical implicationsPsychodynamic psychotherapy teaching methods are effective in increasing students' knowledge of the doctor-patient relationship and potentially also improving their communication skills.
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Qureshi H, Carney S, Iversen A. Narrative review of the impact of clinical psychiatry attachments on attitudes to psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.111.037820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodPsychiatry in the UK has long-standing issues in recruiting UK-trained doctors. A key potential influence on interest in psychiatry during medical school is the clinical attachment. This narrative review investigates how the clinical experience of psychiatry affects medical students' attitudes towards the specialty.ResultsWe identified 107 studies, of which 46 were included. They showed that clinical attachments in psychiatry did result in more positive attitudes towards the specialty and increased career interest. There was inconsistent evidence on whether interest was maintained, with some studies indicating that the increase is transient. Factors which may influence attitudes include attachment setting, duration and student demographics.Clinical implicationsThe results suggest a need to actively maintain interest in psychiatry throughout medical school. Research with long-term follow-up and evaluation of schemes to maintain students' interest is needed.
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Rosenbaum ME. Dis-integration of communication in healthcare education: Workplace learning challenges and opportunities. PATIENT EDUCATION AND COUNSELING 2017; 100:2054-2061. [PMID: 28602566 DOI: 10.1016/j.pec.2017.05.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/28/2017] [Accepted: 05/30/2017] [Indexed: 05/28/2023]
Abstract
The purpose of this paper, based on a 2016 Heidelberg International Conference on Communication in Healthcare (ICCH) plenary presentation, is to examine a key problem in communication skills training for health professional learners. Studies have pointed to a decline in medical students' communication skills and attitudes as they proceed through their education, particularly during their clinical workplace training experiences. This paper explores some of the key factors in this disintegration, drawing on selected literature and highlighting some curriculum efforts and research conducted at the University of Iowa Carver College of Medicine as a case study of these issues. Five key factors contributing to the disintegration of communication skills and attitudes are presented including: 1) lack of formal communication skills training during clinical clerkships; 2) informal workplace teaching failing to explicitly address learner clinical communication skills; 3) emphasizing content over process in relation to clinician-patient interactions; 4) the relationship between ideal communication models and the realities of clinical practice; and 5) clinical teachers' lack of knowledge and skills to effectively teach about communication in the clinical workplace. Within this discussion, potential practical responses by individual clinical teachers and broader curricular and faculty development efforts to address each of these factors are presented.
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Affiliation(s)
- Marcy E Rosenbaum
- Office of Consultation and Research in Medical Education, and Department of Family Medicine, University of Iowa Carver College of Medicine, 1204 MEB, Iowa City, IA 52240, USA.
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Alves ÁTLS, Alves FV, Melo EV, Oliva-Costa EFD. Evaluation of medical interns' attitudes towards relevant aspects of medical practice. Rev Assoc Med Bras (1992) 2017; 63:492-499. [PMID: 28876424 DOI: 10.1590/1806-9282.63.06.492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/19/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: In traditional medical school curriculum, sixth-year is the moment in which students experience medical practice more intensively. Attitudes can be considered predictors of behaviors and actions. Evaluating them contributes to improve medical training. Objective: To evaluate attitudes during medical internship considering medical practice and associated factors in a Brazilian public university. Method: Cross-sectional study that included 69 students, based on a structured questionnaire and an attitude scale (Colares, 2002). We used descriptive statistics, with classification of the attitude tendency, clusters analysis and F-statistics. Results: The average age of the participants was 25.1±1.9, and 56.5% of them were male. Students presented positive attitudes to emotional aspects in organic diseases, primary health care, the medical contribution to the scientific advancement of medicine, and other aspects of medical activity and health politics; there were conflicting attitudes concerning mental illness and negative attitudes concerning death. Conclusion: Results show the need for interventions in order to reduce the identified conflicting and negative attitudes.
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Affiliation(s)
| | - Fernando Vinicius Alves
- Medical Student, Department of Medicine, Universidade Federal de Sergipe (UFS), Aracaju, SE, Brazil
| | - Enaldo Vieira Melo
- PhD, Adjunct Professor, Department of Medicine, UFS, Aracaju, SE, Brazil
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McTighe AJ, DiTomasso RA, Felgoise S, Hojat M. Correlation Between Standardize Patients' Perceptions of Osteopathic Medical Students and Students' Self-Rated Empathy. J Osteopath Med 2017; 116:640-6. [PMID: 27669067 DOI: 10.7556/jaoa.2016.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT The use of standardized patients (SPs) promotes and enhances interpersonal skill sets of medical students and provides a critical opportunity for students to display their relational competence during simulated patient encounters. OBJECTIVE To investigate whether SPs' ratings of osteopathic medical students' empathy and interpersonal skills correlate with students' self-rated empathy. METHODS The study used a cross-sectional quantitative design. After SP encounters, first-, second-, and third-year osteopathic medical students self-rated empathy using the Jefferson Scale of Empathy medical student version. Standardized patients also assessed students' empathy using the Jefferson Scale of Patient Perceptions of Physician Empathy and interpersonal skills using the Professionalism Assessment Ratings Scale. RESULTS Of 780 first-, second-, and third-year students, 717 students returned the survey (91.9%). In total, 383 students were women (53.4%) and 334 were men (46.6%). Of 717 SP encounters, SPs returned surveys for 648 encounters (90.3%). Ratings from SPs regarding their perceptions of osteopathic medical students' empathetic abilities and interpersonal skills did not correlate with students' self-rated empathy scores. Second- and third-year students were perceived by SPs as having better-developed empathetic and interpersonal skill sets when compared with first-year students. Results of SPs' ratings indicated that the higher the interpersonal skills, the higher the SP-perceived empathy for students across all years (r=0.66; P<.001). CONCLUSION Students' self-rated empathy did not correlate with SP-perceived empathy. However, the findings validated that students' core relational competencies increase as they progress through medical school.
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Davis GE, Hartwig WC, McTighe AJ. Clinical Preceptors' Perceptions of Empathy: The Empathy in Osteopathic Training and Education (EMOTE) Study. J Osteopath Med 2017; 117:503-509. [PMID: 28759092 DOI: 10.7556/jaoa.2017.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Context Physician empathy influences rapport with patients and improves outcomes, but it is not well understood as an outcome of osteopathic medical education. Objective To determine how clerkship preceptors at Touro University College of Osteopathic Medicine-CA (TUCOM) in Vallejo define empathy and how they compare observed empathetic behavior of TUCOM students with that of other medical students. Methods Cross-sectional data were obtained from a survey of TUCOM clinical preceptors comparing TUCOM students with other medical students on 10 behaviors. Results were analyzed with a 2-tailed z test of proportional difference at the 95% confidence level. Results Of 650 preceptors contacted, 177 responded and were included in the final analysis (27%). Survey item reliability was high (Cronbach α=0.96). A majority of preceptors (59% to 71%) considered TUCOM students "similar" to other medical students for each behavior. A majority of preceptors (107 [60%]) shared a definition of empathy with one another and with the National Board of Osteopathic Medical Examiners and the American Association of Colleges of Osteopathic Medicine. Approximately 39% of preceptors rated TUCOM students "better" or "advanced" for "displays of empathy" compared with approximately 30% of preceptors who rated students as better or advanced across all 10 behaviors. Preceptors who shared a definition of empathy rated TUCOM students as better or advanced at a significantly higher rate for "displays of empathy" (z=1.982, P<.05) compared with preceptors who did not share a definition (n=70). Osteopathic preceptors (n=67) rated TUCOM students significantly higher on "displays of empathy" (z=2.82, P<.05) and "clear and effective communication to patients, families and co-workers" (z=2.83, P<.01) than did allopathic preceptors. No significant differences were found based on number of years as a preceptor or on the combination of types of students the preceptor taught. Conclusion Most clinical preceptors shared a definition of empathy, and they were able to observe and rate displays of it in clerkship students. Preceptors rated TUCOM students more favorably than other students they taught for displays of empathy.
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Durand MA, Yen R, Barr PJ, Cochran N, Aarts J, Légaré F, Reed M, James O’Malley A, Scalia P, Guérard GP, Elwyn G. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis. BMJ Open 2017; 7:e015945. [PMID: 28645974 PMCID: PMC5541622 DOI: 10.1136/bmjopen-2017-015945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. METHODS AND ANALYSIS The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. ETHICS AND DISSEMINATION The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Malcolm Reed
- Department of Brighton and Sussex Medical School, Dean’s Office, Brighton, UK
| | - A James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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Oikonomidou D, Anagnostopoulos F, Dimitrakaki C, Ploumpidis D, Stylianidis S, Tountas Y. Doctors' Perceptions and Practices of Breaking Bad News: A Qualitative Study From Greece. HEALTH COMMUNICATION 2017; 32:657-666. [PMID: 27367603 DOI: 10.1080/10410236.2016.1167991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There is limited information about doctors' communication behaviors and their salient beliefs with regard to bad news disclosure in Greece. In this qualitative study we investigated the self-reported practices of doctors on breaking bad news, their perceptions about the factors affecting the delivery of such news, and their beliefs about the most appropriate disclosure manner. A focus group discussion and individual interviews were conducted. Twenty-five resident and specialist doctors from primary health care and hospital settings participated. We analyzed the collected data with content analysis techniques. Participants were found to acknowledge the importance of appropriate and effective delivery of bad news; however, none of them reported the implementation of empirically informed communication practices. They described communication patterns mainly formed by their work experience and often guided by the patient's family requests. Doctor, patient, and family characteristics and organizational features and resources were reported to affect the delivery of bad news. Participants perceived the most appropriate disclosure manner as an individualized approach to each patient's unique needs. They suggested an interdisciplinary, collaborative management of the delivery process and the establishment of formal supportive services. These findings may provide useful information for the development of tailored, empirically informed curriculum interventions and educational programs in order to address several barriers to communication. Sociocultural characteristics that influence the disclosure practice, as well as physicians' perceptions that are consistent with the optimal information delivery, should be taken into account. System-level strategies that focus on the development of patient-centered communication also need to be prioritized.
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Affiliation(s)
- Despoina Oikonomidou
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | | | - Christine Dimitrakaki
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
| | - Dimitrios Ploumpidis
- c First Department of Psychiatry, Eginition Hospital , University of Athens Medical School
| | | | - Yannis Tountas
- a Department of Hygiene, Epidemiology and Medical Statistics , University of Athens Medical School
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Tsimtsiou Z, Stavropoulou C, Papastefanou N, Lionis C. Enhancing clinical communication in dermatologists: a personalized educational intervention. J DERMATOL TREAT 2017; 28:647-651. [PMID: 28322070 DOI: 10.1080/09546634.2017.1309348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Effective communication is a vital component of patient-centered consultations with favorable treatment outcomes. This study aimed in testing the effectiveness of a personalized, communication training program for dermatologists in their practices. METHODS Fifteen dermatologists were offered the educational intervention NO.TE.S. (Non-Technical Skills). Depending on the dermatologists' needs, seven to nine sessions with a 60-min duration were performed, focusing on: patient-centered care, principles of Neurolinguistic Programming, a guide to the medical interview, principles of motivational interviewing and self-care. After the program's completion, participants completed anonymously an 18-item evaluation questionnaire. RESULTS All 14 participants would suggest NO.TE.S to a colleague. According to the main themes identified, their participation led to (i) re-consideration of the physician-patient relationship, (ii) more conscious application of the patient-centered model, (iii) improvement in communication skills, (iv) awareness of medical interview guides, (v) increase in self-confidence, and (vi) techniques of self-care. Eleven physicians (78.6%) declared improvement in patients' satisfaction, 14 (100%) in their own satisfaction, seven (50%) in adherence to therapeutic plan and seven (50%) in treatment outcomes. CONCLUSION The one-to-one coaching is a convenient and well-received personalized means of enhancing clinical communication in dermatologists, leading to more patient-centered medical encounters with better treatment outcomes.
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Affiliation(s)
- Zoi Tsimtsiou
- a Department of Hygiene , School of Medicine, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | | | | | - Christos Lionis
- d Clinic of Social and Family Medicine , School of Medicine, University of Crete , Heraklion , Greece
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Hur Y, Cho AR, Choi CJ. Medical students' and patients' perceptions of patient-centred attitude. KOREAN JOURNAL OF MEDICAL EDUCATION 2017; 29:33-39. [PMID: 28264552 PMCID: PMC5339447 DOI: 10.3946/kjme.2017.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 05/29/2023]
Abstract
PURPOSE Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. METHODS A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. RESULTS Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). CONCLUSION Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.
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Affiliation(s)
- Yera Hur
- Department of Medical Education, Konyang University College of Medicine, Daejeon, Korea
| | - A Ra Cho
- Department of Medical Education, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Jin Choi
- Department of Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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