Evaluating Teaching Effectiveness of Medical Humanities in an Integrated Clerkship Program by a Novel Prospective Propensity Score Matching Framework.

William Huang,Hao-Min Cheng,Wan-Yu Yeh,Chung-Li Wu,Kwan-Yee Chan,Cheng-Feng Chen,Ging-Long Wang,Yong Wang,Chen-Huan Chen,Ying-Ying Yang,Chi-Wan Lai,Shuu-Jiun Wang

doi:10.3390/ijerph19031882

Abstract

Background: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. Methods: Between 2013–2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). Results: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. Conclusions: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

Highlights

To cultivate an informed, curious, compassionate, proficient, and moral physician who can serve the needs of future societies [1], the models of clinical training require continuousInt
When we reviewed previous studies which explored the integration of holistic medical education into clinical practice, research on students’ performance in professional skills and humanistic care was rare
A total of 69 C Hospital and 138 B Hospital clerks participated in the study and completed all required questionnaires and Objective Structured Clinical Examination (OSCE) (Figure 1)

Summary

Introduction

Curious, compassionate, proficient, and moral physician who can serve the needs of future societies [1], the models of clinical training require continuousInt. Because it is very difficult to evaluate a new model of clinical clerkships using the experimental design of randomized control trial [14], most studies report quasi-experimental results, namely, the direct comparison of student performance between those who voluntarily received the new clerkships and part or all of those who received the conventional clerkships, with post-hoc adjustments for the differences of the baseline characteristics between the two non-randomized groups [4,5]. This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases

Methods

Results

Conclusion