Maintaining patient-centredness in Australian medical students: Culture, curriculum and selection criteria

Catherine Harding; Alexa Seal; Ruan Vlok; Zelda Doyle; Andrew Dean; Joe McGirr

doi:10.11157/fohpe.v23i2.519

Authors

Catherine Harding The University of Notre Dame AustraliaSchool of Medicine SydneyRural Clinical School (Wagga Wagga)
Alexa Seal The University of Notre Dame Australia School of Medicine Sydney Rural Clinical School (Wagga Wagga)
Ruan Vlok The University of Notre Dame Australia School of Medicine Sydney Rural Clinical School (Wagga Wagga) Work was conducted while Ruan was a student at Notre Dame. He is currently based at Royal North Shore Hospital
Zelda Doyle The University of Notre Dame Australia School of Medicine Sydney Rural Clinical School (Lithgow)
Andrew Dean The University of Notre Dame Australia School of Medicine Sydney Rural Clinical School (Ballarat)
Joe McGirr The University of Notre Dame Australia School of Medicine Sydney Rural Clinical School (Wagga Wagga) Joe was Dean at Notre Dame when the research was conducted. He is now the member of parliament for Wagga Wagga.

DOI:

https://doi.org/10.11157/fohpe.v23i2.519

Keywords:

medical students, patient-centredness, patient practitioner orientation scale (PPOS)

Abstract

Introduction: Previous studies have shown that patient-centredness may become eroded as students progress through medical training. The primary objective of this study was to explore the differences in patient-centred attitudes between first- and final-year students in the context of an Australian medical school. The secondary objective was to determine whether student factors such as age, gender, background (rural/urban), discipline of previous degree and specialty of interest were associated with patient-centred attitudes.

Methods: This cross-sectional study surveyed 214 first-year and 141 final-year Australian medical students in 2016 and 2017 (total n = 355). Score on the Patient–Practitioner Orientation Scale (PPOS) was the main outcome measure.

Results: Anonymous questionnaires were completed by 355 students (76.2%). Mean PPOS score was 4.51 (SD 0.46). Although there was no difference in mean PPOS between first-year and fourth-year students, female respondents were significantly more patient-centred than male respondents (4.58 vs 4.42, p = 0.002). Students with an interest in a surgical specialty had significantly lower patient-centredness than students with a non-surgical specialty of interest (4.36 vs 4.55, p = 0.002). Having general practice intentions was not associated with higher patient-centredness. Students with a previous humanities-based degree had higher patient-centredness than students with previous degrees in different areas (4.67 vs 4.49, p = 0.025).

Conclusions:

There appears to be no erosion of patient-centredness between first-year and fourth/final-year students. Medical student selection and university culture may have influenced this finding.

References

Ahmad, W., Krupat, E., Asma, Y., Fatima, N. E., Attique, R., Mahmood, U., & Waqas, A. (2015). Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship. Peer Journal, 3, e1050. https://doi.org/10.7717/peerj.1050

Altin, S. V., & Stock, S. (2016). The impact of health literacy, patient-centered communication and shared decision-making on patients' satisfaction with care received in German primary care practices. BMC Health Services Research, 16(1), Article 450. http://doi.org/10.1186/s12913-016-1693-y

Archer, E., & Meyer, I. S. (2021). Applying empathic communication skills in clinical practice: Medical students’ experiences. South African Family Practice, 63(1), e1–e5. https://doi.org/10.4102/safp.v63i1.5244

Aper, L., Veldhuijzen, W., Dornan, T., van de Ridder, M., Koole, S., Derese, A., & Reniers, J. (2015). “Should I prioritise medical problem solving or attentive listening?”: The dilemmas and challenges that medical students experience when learning to conduct consultations. Patient Education and Counseling, 98(1), 77–84. https://doi.org/10.1016/j.pec.2014.09.016

Baile, W. F., Buckman, R., Lenzi, R., Glober, G., Beale, E. A., & Kudelka, A. P. (2000). SPIKES—A six-step protocol for delivering bad news: Application to a patient with cancer. The Oncologist, 5(4), 302–311. https://doi.org/10.1634/theoncologist.5-4-302

Balentine, C., Ayanbule, F., Haidet, P., Rogers, J., Thompson, B., Chang, T., Horwitz, I., Tseng, E., & Berger, D. H. (2010). The patient–physician relationship in surgical students. American Journal of Surgery, 200(5), 624–627. https://doi.org/10.1016/j.amjsurg.2010.07.004

Balint, M., Ball, D., & Hare, M. (1969). Training medical students in patient-centred medicine. Comprehensive Psychiatry, 10(4), 249–258. https://doi.org/10.1016/0010-440x(69)90001-7

Bombeke, K., Symons, L., Debaene, L., De Winter, B., Schol, S., & Van Royen, P. (2010). Help, I’m losing patient-centredness! Experiences of medical students and their teachers. Medical Education, 44(7), 662–673. https://doi.org/10.1111/j.1365-2923.2010.03627.x

Boutin-Foster, C., Foster, J. C., & Konopasek, L. (2008). Physician, know thyself: The professional culture of medicine as a framework for teaching cultural competence. Academic Medicine, 83(1), 106–111. https://doi.org/10.1097/ACM.0b013e31815c6753

Branch, W. T., Jr., Kern, D., Haidet, P., Weissmann, P., Gracey, C. F., Mitchell, G., & Inui, T. (2001). Teaching the human dimensions of care in clinical settings. JAMA, 286(9), 1067–1074. https://doi.org/10.1001/jama.286.9.1067

Fallowfield, L. (2008). Treatment decision-making in breast cancer: The patient–doctor relationship. Breast Cancer Research and Treatment, 112(1), 5–13. https://doi.org/10.1007/s10549-008-0077-3

Gilligan, C., Brubacher, S. P., & Powell, M. B. (2020). Assessing the training needs of medical students in patient information gathering. BMC Medical Education, 20(1), Article 61. https://doi.org/10.1186/s12909-020-1975-2

Goldfarb, M. J., Bibas L., Bartlett, V., Jones, H., & Khan, N. (2017). Outcomes of patient- and family-centered care interventions in the ICU: A systematic review and meta-analysis. Critical Care Medicine, 45(10), 1751–1761. https://doi.org/10.1097/CCM.0000000000002624

Gordon, J. S. (2014). Mind–body skills groups for medical students: Reducing stress, enhancing commitment, and promoting patient-centered care. BMC Medical Education, 14(1), Article 198. https://doi.org/10.1186/1472-6920-14-198

Hafferty, F., & Franks, R. (1994). The hidden curriculum, ethics teaching, and the structure of medical education. Academic Medicine, 69(11), 861–871. https://doi.org/10.1097/00001888-199411000-00001

Hafferty, F. W., Gaufberg, E. H., & O'Donnell, J. F. (2015). The role of the hidden curriculum in "on doctoring" courses. AMA Journal of Ethics, 17(2), 130–139. https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/medu1-1502.pdf

Haidet, P., Dains, J. E., Paterniti, D. A., Hechtel, L., Chang, T., Tseng, E., & Rogers, J. C. (2002). Medical student attitudes toward the doctor–patient relationship. Medical Education, 36(6), 568–574. https://doi.org/10.1046/j.1365-2923.2002.01233.x

Hardeman, R. R., Burgess, D., Phelan, S., Yeazel, M., Nelson, D., & van Ryn, M. (2015). Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study. Patient Education and Counseling, 98(3), 350–355. https://doi.org/10.1016/j.pec.2014.11.013

Hauer, K. E., Boscardin, C., Gesundheit, N., Nevins, A., Srinivasan, M., & Fernandez, A. (2010). Impact of student ethnicity and patient-centredness on communication skills performance. Medical Education, 44(7), 653–661. https://doi.org/10.1111/j.1365-2923.2010.03632.x

Hirshfield, L. E., Yudkowsky, R., & Park, Y. S. (2019). Pre-medical majors in the humanities and social sciences: Impact on communication skills and specialty choice. Medical Education, 53(4), 408–416. https://doi.org/10.1111/medu.13774

Jones, E. K., Kumagai, A. K., & Kittendorf, A. L. (2019). Through another lens: The humanities and social sciences in the making of physicians. Medical Education, 53(4), 328–330. https://doi.org/10.1111/medu.13817

Krupat, E., Hiam, C., Fleming, M., & Freeman, P. (1999). Patient-centredness and its correlates among first year medical students. International Journal of Psychiatry in Medicine, 29(3), 347–356. https://doi.org/10.2190/DVCQ-4LC8-NT7H-KE0L

Krupat, E., Pelletier, S., Alexander, E. K., Hirsh, D., Ogur, B., & Schwartzstein, R. (2009). Can changes in the principal clinical year prevent the erosion of students' patient-centered beliefs? Academic Medicine, 84(5), 582–586. https://doi.org/10.1097/acm.0b013e31819fa92d

Krupat, E., Rosenkranz, S. L., Yeager, C. M., Barnard, K., Putnam, S. M., & Inui, T. S. (2000). The practice orientations of physicians and patients: The effect of doctor–patient congruence on satisfaction. Patient Education and Counseling, 39(1), 49–59. https://doi.org/10.1016/S0738-3991(99)00090-7

Lawrence, C., Mhlaba, T., Stewart, K. A., Moletsane, R., Gaede, & B., Moshabela, M. (2018). The hidden curricula of medical education: A scoping review. Academic Medicine, 93(4), 648–656. https://doi.org/10.1097/acm.0000000000002004

Lee, K., Seow, A., Luo, N., & Koh, D. (2008). Attitudes towards the doctor–patient relationship: A prospective study in an Asian medical school. Medical Education, 42(11), 1092–1099. https://doi.org/10.1111/j.1365-2923.2008.03157.x

Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., Ferrier, K., & Payne, S. (2001). Preferences of patients for patient-centred approach to consultation in primary care: Observational study. BMJ, 322(7284), 468–472. https://doi.org/10.1136/bmj.322.7284.468

Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science Medicine, 51(7), 1087–1110. https://doi.org/10.1016/s0277-9536(00)00098-8

Metz, G., Catford, J., & Kinkade, A. (2013). Attitudes of a private hospital community to medical student teaching. Medical Journal of Australia, 199(6), 396. https://doi.org/10.5694/mja13.10869

Moyo, M., Shulruf, B., Weller, J., & Goodyear-Smith, F. (2019). Effect of medical students’ values on their clinical decision-making. Journal of Primary Health Care, 11(1), 64–74. https://doi.org/10.1071/hc18055

Ogur, B., & Hirsh, D. (2009). Learning through longitudinal patient care: Narratives from the Harvard Medical School–Cambridge integrated clerkship. Academic Medicine, 84(7), 844–850. https://doi.org/10.1097/acm.0b013e3181a85793

Ogur, B., Hirsh, D., Krupat, E., & Bor, D. (2007). The Harvard Medical School–Cambridge integrated clerkship: An innovative model of clinical education. Academic Medicine, 82(4), 397–404. https://doi.org/10.1097/acm.0b013e31803338f0

Patterson, F., Prescott-Clements, L., Zibarras, L., Edwards, H., Kerrin, M., & Cousans, F. (2016). Recruiting for values in healthcare: A preliminary review of the evidence. Advances in Health Science Education Theory and Practice, 21(4), 859–881. https://doi.org/10.1007/s10459-014-9579-4

Paul-Savoie, E., Bourgault, P., Gosselin, E., Potvin, S., & Lefrenaye, S. (2015). Assessing patient-centre care: Validation of the French version of the patient–practitioner orientation scale (PPOS). European Journal for Person Centred Healthcare, 3(3): 295–302. http://www.ejpch.org/ejpch/article/view/956/0

Pereiraa, C. M. A. S., Amaral, C. F. S., Ribeiro, M. M. R., Paro, H. B. M. S., Pinto, R. M. C., Reis, L. E. T., Silva, C. H. M., & Krupat, E. (2013). Cross-cultural validation of the Patient–Practitioner Orientation Scale (PPOS). Patient Education and Counseling, 91(1), 37–43. https://doi.org/10.1016/j.pec.2012.11.014

Perestelo-Pérez, L., Rivero-Santana, A., González-González, A. I., Bermejo-Caja, C. J., Ramos-García, V., Koatz, D., Torres-Castaño, A., Ballester, M., Muñoz-Balsa, M., del Rey-Granado, Y., Pérez-Rivas, F. J., Canellas-Criado, Y., Ramírez-Puerta, A. B., Pacheco-Huergo, V., & Orrego, C. (2021). Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain. Health Expectations, 24(1), 33–41. https://doi.org/10.1111/hex.13135

Quinlivan, J., Lam, L., Wan, S., & Petersen, W. (2010). Selecting medical students for academic and attitudinal outcomes in a Catholic medical school. Medical Journal of Australia, 193(6), 347–350. https://doi.org/10.5694/j.1326-5377.2010.tb03947.x

Rao, J., Weinberger, M., & Kroenke, K. (2000). Visit-specific expectations and patient-centered outcomes: A literature review. Archives of Family Medicine, 9(10), 1148–1155. https://doi.org/10.1001/archfami.9.10.1148

Rapport, N. (2014). Social and cultural anthropology: The key concepts (3rd ed.). Routedge.

Ribeiro, M., Krupat, E., & Amaral, C. (2007). Brazilian medical students’ attitudes towards patient-centered care. Medical Teacher, 29(6), e204–e208. https://doi.org/10.1080/01421590701543133

Rosewilliam, S., Indramohan, V., Breakwell, R., & Skelton, J. (2020). Learning to be patient-centred healthcare professionals: How does it happen at university and on clinical placements? A multiple focus group study. MedEdPublish, 9(53). https://doi.org/10.15694/mep.2020.000053.1

Roter, D. L., & Hall, J. A. (2004). Physician gender and patient-centered communication: A critical review of empirical research. Annual Review of Public Health, 25, 497–519. https://doi.org/10.1146/annurev.publhealth.25.101802.123134

Saha, S., & Beach, M. C. (2011). The impact of patient-centered communication on patients’ decision making and evaluations of physicians: A randomized study using video vignettes. Patient Education and Counseling, 84(3), 386–392. https://doi.org/10.1016/j.pec.2011.04.023

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centre care: A conceptual framework. Health Expectations, 21(2), 429–440. https://doi.org/10.1111/hex.12640

Say, R. E., & Thompson, R. (2003). The importance of patient preferences in treatment decisions: Challenges for doctors. BMJ, 327(7414), 542–545. https://doi.org/10.1136/bmj.327.7414.542

Shankar, P. R., Dubey, A. K., Subish, P., & Deshpande, V. Y. (2006). Attitudes of first-year medical students towards the doctor patient relationship. Journal of Nepal Medical Association, 45(161), 196–203. https://pubmed.ncbi.nlm.nih.gov/17160097/

Simpson, M., Buckman, R., Stewart, M., Maguire, P., Lipkin, M., Novack, D., & Till, J. (1991). Doctor-patient communication: The Toronto consensus statement. BMJ, 303(6814), 1385–1387. https://doi.org/10.1136/bmj.303.6814.1385

Spencer, J. (2004). Decline in empathy in medical education: How can we stop the rot? Medical Education, 38(9), 916–918. https://doi.org/10.1111/j.1365-2929.2004.01965.x

Stewart, M. (2001). Towards a global definition of patient-centred care. BMJ, 322(2784), 444–445. https://doi.org/10.1136/bmj.322.7284.444

Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., & Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of Family Practice, 49(9), 796–804. https://www.mdedge.com/jfponline/article/60893/impact-patient-centered-care-outcomes

Tiong, M., Levinson, M., Oldroyd, J., & Staples, M. (2013). How receptive are patients to medical students in Australian hospitals? A cross‐sectional survey of a public and a private hospital. Internal Medicine Journal, 43(4), 373–380. https://doi.org/10.1111/j.1445-5994.2012.02887.x

Tsimtsiou, Z., Kerasidou, O., Efstathiou, N., Papaharitou, S., Hatzimouratidis, K., & Hatzichristou, D. (2007). Medical students' attitudes toward patient‐centred care: A longitudinal survey. Medical Education, 41(2), 146–153. https://doi.org/10.1111/j.1365-2929.2006.02668.x

Wahlqvist, M., Gunnarsson, R., Dahlgren, G., & Nordgren, S. (2010). Patient-centred attitudes among medical students: Gender and work experience in health care make a difference. Medical Teacher, 32(4), e191–e198. https://doi.org/10.3109/01421591003657451

Wang, J., Zou, R., Fu, H., Qian, H., Yan, Y., & Wang, F. (2017). 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. BMJ Open, 7(9), e016902. https://doi.org/10.1136/bmjopen-2017-016902

Wilcox, M. V., Orlando, M. S., Rand, C. S., Record, J., Christmas, C., Ziegelstein, R. C., & Hanyok, L. A. (2017). Medical students’ perceptions of the patient-centredness of the learning environment. Perspectives on Medical Education, 6(1), 44–50. https://doi.org/10.1007/s40037-016-0317-x

Williams, S., Weinman, J., & Dale, J. (1998). Doctor–patient communication and patient satisfaction: A review. Family Practice, 15(5), 480–492. https://doi.org/10.1093/fampra/15.5.480