The effect of a patient- and family-centered care curriculum on pediatrics residents' patient-centeredness

Early longitudinal experiences increase medical student self-efficacy

This article was migrated. The article was marked as recommended. Background: The purpose of this study was to investigate the impact of early longitudinal preceptorship experiences on the evolution of general self-efficacy and patient-centeredness self-efficacy through medical school. Methods:Validated surveys for general self-efficacy and patient-centeredness self-efficacy were administered in an allopathic medical school at three timepoints. These data were stratified by traditional and longitudinal preceptorship groups and analyzed using Generalized Estimating Equations. Qualitative analysis of narrative medicine essays by the same cohort during their preceptorship experiences was also performed. Results: While general self-efficacy remained largely unchanged over time, patient-centeredness self-efficacy measures increased throughout medical school in the whole cohort (N=157). The longitudinal preceptorship group had higher gains in patient-centeredness self-efficacy, especially in the domain of exploring patient perspectives (p<0.05). The qualitative analysis of narrative medicine essays showed those in longitudinal preceptorships were more likely to discuss health care systems issues, consider psychosocial factors, and perceive themselves as active members of the care team. Discussion:Our study indicates greater patient-centeredness attitudes over time among students who have early longitudinal experiences, perhaps due to the self-efficacy building nature of these experiences. Our research suggest that medical school programs should consider incorporating opportunities for early longitudinal clinical experiences for their students.

Family-centred service: Perspectives of paediatric residents from a non-Western country

OBJECTIVES

The concept of family-centred service (FCS), which is recognized as the standard of paediatric health care, emerged from Western countries, and integration of FCS can be challenging especially in non-Western countries. This study aims to explore family-centred behaviours of paediatric residents and their perspectives on FCS being trained in a non-Western country before and 6 months after an educational workshop. It was hypothesized that the workshop will increase the awareness of paediatric residents regarding FCS and improve their self-reported family-centred practices.

STUDY DESIGN

Ninety-nine residents who are in a 4-year paediatric residency program were included. A 2-hr interactive workshop was conducted for all participants. The measure of processes of care for service providers was used to measure self-reported family-centred practices of paediatric residents, and a study specific questionnaire was utilized to understand their perspectives towards FCS prior to and 6 months after the workshop.

RESULTS

There were statistically significant increases in the measure of processes of care for service providers scores suggesting improvements in self-reported family-centred practices of participants 6 months after the workshop. Moreover, the percentage of participants describing themselves as knowledgeable and competent increased. Viewpoints of paediatric residents on the implementation of FCS and several challenges perceived by participants were highlighted.

CONCLUSION

This is the first study conducted in a non-Western country exploring perspectives of paediatric residents towards the implementation of FCS and measuring their self-reported family-centred practices before and after an educational workshop. The study revealed that although a 2-hr interactive workshop improved the self-reported family-centred practices of participants, they still found FCS challenging.

Humanization interventions in general pediatric wards: a systematic review

Humanization of care (HOC) interventions have rarely been evaluated and compared. We systematically reviewed the outcomes of published interventions aimed to improve the HOC for hospitalized children. PubMed and Scopus were used as data sources. Studies published between January 1, 2000, and February 28, 2018, were considered eligible if they reported analysis of results vs. either a control group or baseline, or if they measured patient/family/staff satisfaction. Neonatal age, emergency departments, and subspecialty settings were excluded. Data were extracted using a standardized data extraction form including study design, sample size, intervention, outcome/objective, and evaluation of results or pre- post-intervention satisfaction. Twenty-eight of the 12,012 retrieved articles met the inclusion criteria. Most studies were of moderate to low quality. Only six studies were of high quality. Areas of interest dealt with environment (n = 4), provider-patient relationship (n = 6), pet therapy (n = 5), technology (n = 5), family-centered rounds (n = 2), psychological support (n = 3), and staff training (n = 3). The overall trend of the results indicated that interventions were mostly effective and likely to have beneficial effects on several aspects of pediatric hospitalization.Conclusions: Pending further studies of better research quality, the findings of this review may have policy and practice implications for planning HOC interventions by pediatric healthcare professionals. What is Known: • In pediatrics, humanization of care (HOC) provides assistance focused not only on the child as a patient, but on the whole family. • HOC programs have been developed, but information on the overall outcome of local projects aiming to improve in a practical way the hospital taking charge of pediatric patients is still lacking. What is New: • Local HOC interventions are mostly effective and have beneficial effects on several aspects of hospitalization in general pediatrics wards. • The findings of this review may have practice implications for planning HOC interventions by pediatric healthcare professionals.

Needs Assessment for a Medical Home Curriculum for Pediatric Residents

Several studies and the Accreditation Council for Graduate Medical Education recommend integration of medical home (MH) concepts into pediatric resident training. There is a paucity of research depicting the current landscape of pediatric resident MH education. We hypothesized formal MH curricula in pediatric residency education are limited and pediatric residency programs desire incorporating MH education into curricula. A national needs assessment of pediatric residency programs was conducted assessing inclusion of MH concepts in training. Outcomes assessed were perceived importance of including MH concepts, satisfaction of current curriculum, content taught, resources available, and barriers encountered. Fifty-six programs (28%) completed the survey, majority academic programs. Nearly 75% indicated interest in incorporating MH concepts. Fifty-one percent of programs reported faculty knowledgeable in MH concepts/implementation and 11% reported access to readily available resources. Barriers included resident schedules, faculty teaching time, funding, and not faculty priority. Pediatric program directors report interest and need for improved MH training but identify implementation barriers.

Measuring the preference towards patient-centred communication with the Chinese-revised Patient-Practitioner Orientation Scale: a cross-sectional study among physicians and patients in clinical settings in Shanghai, China

OBJECTIVES

To adapt the Patient-Practitioner Orientation Scale (PPOS), to a Chinese context, and explore the preference towards patient-centred communication among physicians and patients with the Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS).

DESIGN

A cross-sectional questionnaire-based study.

SETTING

Clinical settings from eight medical units, including four community hospitals and four general hospitals, in Shanghai, China.

PARTICIPANTS

1018 participants, including 187 physicians and 831 patients, completed this study in two successive stages.

OUTCOME MEASUREMENTS

Psychometric properties of the CR-PPOS and participants' score on the CR-PPOS.

RESULTS

Compared with the original PPOS, the 11-item CR-PPOS obtained better psychometric indices. Physicians and patients scored differently on both the total CR-PPOS and its two subscales. Compared with physicians, the scores of patients were more influenced by their personal characteristics, such as age and education.

CONCLUSIONS

The CR-PPOS is a better instrument in a Chinese context than the original translated version. The divergence in the extent to which patient-centred communication is preferred among Chinese physicians and patients should be noted. Adapting physicians' communication strategy to patients' preferences based on their personal characteristics can be a viable approach towards improving clinical efficiency.

Humanization of pediatric care in the world: focus and review of existing models and measurement tools

Background

The term “humanization” indicates the process by which people try to make something more human and civilized, more in line with what is believed to be the human nature. The humanization of care is an important and not yet a well-defined issue which includes a wide range of aspects related to the approach to the patient and care modalities. In pediatrics, the humanization concept is even vaguer due to the dual involvement of both the child and his/her family and by the existence of multiple proposed models.

Objective

The present study aims to analyze the main existing humanization models regarding pediatric care, and the tools for assessing its grade.

Results

The main Humanization care programs have been elaborated and developed both in America (Brazil, USA) and Europe. The North American and European models specifically concern pediatric care, while the model developed in Brazil is part of a broader program aimed at all age groups. The first emphasis is on the importance of the family in child care, the second emphasis is on the child’s right to be a leader, to be heard and to be able to express its opinion on the program’s own care. Several tools have been created and used to evaluate humanization of care programs and related aspects. None, however, had been mutually compared.

Conclusions

The major models of humanization care and the related assessment tools here reviewed highlight the urgent need for a more unifying approach, which may help in realizing health care programs closer to the young patient’s and his/her family needs.

Electronic supplementary material

The online version of this article (10.1186/s13052-017-0394-4) contains supplementary material, which is available to authorized users.