How can a micro-level communication training intervention help medical students learn about patient-centered care and empathy? Qualitative results of a design-based research

University of Missouri School of Medicine in Columbia

BackgroundPatient 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.MethodsAn 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.ResultsThe 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).ConclusionsSeveral 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.

Contribution and responsibility of patients in the area of patient safety is encouraged by the Dutch government. Technology has provided the means to give the patient better access to health care information. The role of the patient is changing. In the past health care providers had a more paternal approach (the patient does exactly what(ever) the doctor says), whereas nowadays the doctor and patient make decisions together. Furthermore, people are starting to organize their own health care. Health care providers offer expertise and support instead of making decisions for the patients. (VWS,2014) As an answer to this different approach, the Jeroen Bosch Hospital has developed several actions. Joost van de Mortel (2013) made it clear with a qualitative research (N=13) the hospital (community) is open to the application of patient empowerment and already applies it, consciously or subconsciously. Despite the good intentions, there are misconceptions regarding patient empowerment that obstruct proper application. In the organization the structure, applied systems and the lack of a management model in which patient empowerment is central, prevent full implementation of patient empowerment. In a consecutive study Jean Marc Reinold (2014) made an inventory which functionalities in a patient portal (“An online gateway that gives the patient control in gathering and sharing information about their health through multiple websites and / or functionalities”) would contribute to ‘patient empowerment’. Besides an extensive literature review, the researcher has gathered information by means of a questionnaire (168 patients, a 95% reliable sample), focus group discussion with 7 patients and the result of a Digi panel inquiry (50% of the 150 panel members i.c. patients responded) of the Jeroen Bosch Hospital (JBZ). The research made clear the patients want to have direct access to their complete medical record, including lab results, research results and imagery. The function ‘inspection of medical records’ makes it possible to take more control of their own treatment (patient empowerment). Besides seeing their medical records the patients of the JBZ want to be able to make several (combined) appointments themselves and to have the possibility of email correspondence with their own doctor. The real empowering ability of a patient portal has to do with the attitude of the doctor and his patient to move towards dialogue and cooperation. This means that in addition to the practical development and implementation of the portal, now in progress after the deployment of the Electronic Patient File (EPF), the strategic reasons for the use of the portal need to be promoted and spread within the organization. To implement the portal successfully within the organization some misunderstandings among the staff has to be resolved: - the abilities of the patients regarding eHealth are sufficient in general and still developing, - the exact content of the patient portal (test-results, images, diagnosis/reports, treatment plan) by using a demo, - the influence on the work processes and financial consequences . Further staff training and a helpdesk should facilitate the implementation. Direct active involvement in the development and implementation of the patient portal of motivated patients will contribute to increasing support and will have a positive marketing effect. Use of e-Health and patient empowerment is a powerful combination. Technology and most patients are ready, a lot of professionals in health care in the Netherlands are positive on patient empowerment and are using e-Health fragmented. Barriers to implement are merely the absence of a clear policy of the organization, the organizational structure, the systems, the skills and attitude of a minority of the professionals and the adjustment of the system of financial compensation (a negotiation with the insurance companies is necessary to compensate digital interaction with the patient). In a presentation the impact and outcomes of several actions to improve patient empowerment and e-Health (project Digital Working) within the Jeroen Bosch Hospital and developments on the implementation of eHealth in the Netherlands can be shared. References : 1- Reinold, Jean Marc, Zelfregie voor patienten door een patienten portaal (dutch), Jeroen Bosch Ziekenhuis, den Bosch. 2014. 2- Mortel, Joost van de, Patient empowerment in het Jeroen Bosch Ziekenhuis: realiteit of utopie? (dutch), Jeroen Bosch Ziekenhuis, den Bosch. 2013. 3- VWS (Ministry of Health, Welfare and Sports), De maatschappij verandert. Verandert de zorg mee? Ministerie van Volksgezondheid, Welzijn en Sport. Den Haag. 2014.

Contribution and responsibility of patients in the area of patient safety is encouraged by the Dutch government.Technology has provided the means to give the patient better access to health care information. The role of the patient is changing. In the past health care providers had a more paternal approach (the patient does exactly what(ever) the doctor says), whereas nowadays the doctor and patient make decisions together. Furthermore, people are starting to organize their own health care. Health care providers offer expertise and support instead of making decisions for the patients. (VWS,2014)As an answer to this different approach, the Jeroen Bosch Hospital has developed several actions.Joost van de Mortel (2013) made it clear with a qualitative research (N=13) the hospital (community) is open to the application of patient empowerment and already applies it, consciously or subconsciously. Despite the good intentions, there are misconceptions regarding patient empowerment that obstruct proper application. In the organization the structure, applied systems and the lack of a management model in which patient empowerment is central, prevent full implementation of patient empowerment.In a consecutive study Jean Marc Reinold (2014) made an inventory which functionalities in a patient portal (“An online gateway that gives the patient control in gathering and sharing information about their health through multiple websites and / or functionalities”) would contribute to ‘patient empowerment’.Besides an extensive literature review, the researcher has gathered information by means of a questionnaire (168 patients, a 95% reliable sample), focus group discussion with 7 patients and the result of a Digi panel inquiry (50% of the 150 panel members i.c. patients responded) of the Jeroen Bosch Hospital (JBZ).The research made clear the patients want to have direct access to their complete medical record, including lab results, research results and imagery. The function ‘inspection of medical records’ makes it possible to take more control of their own treatment (patient empowerment). Besides seeing their medical records the patients of the JBZ want to be able to make several (combined) appointments themselves and to have the possibility of email correspondence with their own doctor. The real empowering ability of a patient portal has to do with the attitude of the doctor and his patient to move towards dialogue and cooperation.This means that in addition to the practical development and implementation of the portal, now in progress after the deployment of the Electronic Patient File (EPF), the strategic reasons for the use of the portal need to be promoted and spread within the organization.To implement the portal successfully within the organization some misunderstandings among the staff has to be resolved:- the abilities of the patients regarding eHealth are sufficient in general and still developing,- the exact content of the patient portal (test-results, images, diagnosis/reports, treatment plan) by using a demo,- the influence on the work processes and financial consequences .Further staff training and a helpdesk should facilitate the implementation.Direct active involvement in the development and implementation of the patient portal of motivated patients will contribute to increasing support and will have a positive marketing effect.Use of e-Health and patient empowerment is a powerful combination. Technology and most patients are ready, a lot of professionals in health care in the Netherlands are positive on patient empowerment and are using e-Health fragmented.Barriers to implement are merely the absence of a clear policy of the organization, the organizational structure, the systems, the skills and attitude of a minority of the professionals and the adjustment of the system of financial compensation (a negotiation with the insurance companies is necessary to compensate digital interaction with the patient).In a presentation the impact and outcomes of several actions to improve patient empowerment and e-Health (project Digital Working) within the Jeroen Bosch Hospital and developments on the implementation of eHealth in the Netherlands can be shared.

BackgroundUnderstanding the perceived importance of Patient-Centered Care (PCC) among Palestinian doctors and how the provider and other clinical characteristics may impact their views on PCC is essential to determine the extent to which PCC can be implemented. This study investigates the provision of PCC among hospital doctors in a developing and unstable country, namely, Palestine.MethodsThis descriptive, cross-sectional research employed self-report survey among 369 Palestinian doctors working in hospitals in 2016. Respondents completed the Provider-Patient Relationship Questionnaire (PPRQ) and were asked to rate the importance of 16 PCC subjects in a context-free manner. Then they scored the existence of eight contextual attributes in their workplace.ResultsAlthough 71.4% of the participants got training in communication, only 45% of the participants knew about PCC. 48.8% of doctors considered the “exchange of information” with patients most important PCC component. Clustering identified three groups of doctors: 32.4% of doctors reported good perceptions of PCC, 47.5% moderate; and 20.1% poor. Older, married, and specialist doctors and those familiar with PCC are more likely classified in the “good” cluster. Results revealed a significant difference between doctors’ views based on their gender, experience, marital status, previous knowledge about PCC, and type of hospital in favor of males, experienced, married, familiar with PCC, and doctors in private hospital respectively. The level of job interest, nurses’ cooperation, the tendency of patients to hide information, and doctor’s friendly style were positively related with more perceived importance of PCC.ConclusionWe identified benchmark doctors who perceive the high relative importance of PCC. Our results highlighted knowledge gaps and training weaknesses among doctors in public and private hospitals in respect to their views on PCC. Decision makers may invest in the determined contextual predictors to enhance attitudes towards PCC. This work doesn’t address patients’ views on PCC.

377TF The Patient Experience: Increasing Medical Student Awareness of Patient-Centered Care

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

ABSTRACTPhenomenon: 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.

Background The patient being the focus of all medical sciences therapy, patient-centered care is found to be more beneficial in improving the efficacy of care. It is now being emphasized that this competency of patient-centered care should be developed at the level of undergraduate. It is hoped that with time and experience medical students may develop this competency as a reflex in their clinical practice. Data about the attitude of medical students towards patient-centered care is variable. As well as comparative data as to which curriculum (i.e. traditional versus integrated) enhances this quality is also insufficient. Objective The objective of this study is to compare the "patient-centered care" attitude of medical students from an integrated versus traditional curriculum. Methods A cross-sectional, comparative study was conducted at Liaquat national hospital and Medical College from June to December 2017. The sampling technique was non-probability convenience sampling. The calculated sample size was 110 participants in each group. Group A had medical students from the final year current batch and passed out batch (traditional curriculum) while Group B had medical students from current fourth and final year (Integrated curriculum). After consent, a validated questionnaire i.e. patient-physician orientation scale (PPOS) was given to students. Data was analyzed by SPSS version 23. Descriptive analysis was done to compute central tendencies and standard deviation and the Students' t-test, was applied. A P-value of 0.05 was considered significant. Results Out of 350 students participating in the study, male and female participants were 29.14% (102/350) and 70.85% (248/350) respectively. The mean age was 21.99 ±1.73. Traditional curricular medical students had significantly better total PPOS scores as compared with integrated curriculum students. Females also had significantly better scores than males (p=0.04). Conclusion Results suggest that an integrated medical curriculum should be reviewed and strategies that promote patient-centered care should be incorporated into all phases of student learning.

Patient-centered care is upheld as one of the fundamental components of high quality health care. Although a deceptively easy concept, patient-centered care is an elusive goal in clinical practice. A core objective for patient-centered care is a collaboration between health care providers and patients that aligns therapy with patients' values and preferences through shared decision making. Advances in communication training that are tailored to the specific requirements of nephrology care are promising methods for enhancing the skill-set of our providers. However, patient-centered care extends beyond shared decision-making and also involves attention to patients' physical and emotional symptoms, care coordination, and the inclusion of family members. Research about patient-centered care processes, interventions and outcomes among patients with kidney disease is sparse. Recent discussions among nephrology experts name patient-centered care as a priority for research and quality improvement in care. Given recent advances in methods for quantifying patient-centered care as well as patient reported outcomes, now is the time to prioritize our resources to evolve our health system and meet the needs of all patients with kidney disease.

Patient-centredness should be at the heart of medical education. This longitudinal study aimed to assess possible attitude changes towards patient-centredness in a medical students' cohort as they progressed through the clinical curriculum. It also investigated the possible impact of socio-demographic factors on students' attitudes. The same student cohort was tested on 2 occasions: during their initial exposure to clinical curricula (year 4) and after 2 years, at the end of the clerkship (year 6). Students completed a questionnaire including demographics and the 18-item Patient-Practitioner Orientation Scale (PPOS). PPOS differentiates between patient-centred versus doctor-centred or disease-centred orientation, measuring attitudes along 2 dimensions: 'sharing' and 'caring'. A total of 483 fully completed questionnaires was returned (response rate 83%). The cohort's attitudes were significantly more doctor-centred at the end of their studies compared to the beginning of their clinical curricula (P < 0.001). However, regarding the caring part of their relationship with patients, they maintained a satisfactory level of patient-centredness. Concerning sharing information, female students were significantly more patient-centred at year 4, with their mean score decreasing at the end of their clerkship. Furthermore, among only female students, having a looser relationship with religion was associated with more patient-centred attitudes. Increased authoritarianism in graduating students' attitudes emphasises clearly the need for future research and redesigning communication curricula. Furthermore, the influence of gender and relationship with religion on attitudes towards the doctor-patient relationship should be explored further, in order to eliminate disparities in the provision of patient-centred medical care.

Purpose Given barriers of patient-centred care (PCC) among physicians and trainees, this study assessed how medical schools addressed PCC in curriculum. Method The authors used content analysis to describe PCC in publicly-available curriculum documents of Canadian medical schools guided by McCormack’s PCC Framework, and reported results using summary statistics and text examples. Results The authors retrieved 1459 documents from 16 medical schools (median 49.5, range 16–301). Few mentioned PCC (301, 21.2%), and even fewer thoroughly or accurately described PCC. Significantly more clerkship versus pre-clerkship (24.0% vs 12.6%, p < 0.00001), and elective compared with core course descriptions (24.7% vs 14.9%, p < 0.00001) mentioned PCC. The domain of foster a healing relationship was common (79.0%) compared with other domains: address concerns (16.5%), exchange information (14.9%), enable self-care (10.4%), share decisions (4.5%), and manage uncertainty (1.3%). Conclusions Overall, few documents mentioned or described PCC or related concepts. This varied by school, and was more frequent in clerkship and elective courses, suggesting that student exposure may be brief and variable. Thus, it remains unclear if medical students are fully exposed to what PCC means and how to implement it. Future research is needed to confirm if PCC content in medical curriculum is lacking.

Patient-centered care (PCC) is a popular movement among health services re- searchers, health policy analysts, and health professionals. PCC requires that patient needs, preferences, and beliefs be respected at all times. The PCC movement is an outgrowth of macrosocial trends, including the aging of the population, the growth of chronic illness, the focus on quality, the advent of managed care, and the realization that psychosocial factors impact on health. Although recognizing the import of psychosocial factors, PCC still lacks an overarching integrative theory that explains how biological and psychosocial factors can simultaneously affect health. Thus, communication research and clinical research from the PCC perspective tend toward the two poles of biomedical realism or social constructionism, neither of which offer a satisfactory account of health. To put communication research on a firmer footing with respect to PCC, and to avoid the discourse of dualism, this article describes an integrative theory (based on the mangle of practice) wherein health is seen as an interactively stabilized configuration of self-image, interpretive accounts, and per- formances. The implications of this perspective for communication research and training are discussed, and the article concludes with a consideration of the problems that still face the PCC movement.

&lt;p&gt;&lt;span lang="EN-US"&gt;Patient Centered Care (PCC) is a new paradigm in health care service that places patients as centers of care. Patient Centered Care in the relationship quality model consists of three components, namely: (1) pharmacist participative behavior, (2) interpersonal communication and (3) patient participative behaviour. This study aims to empirical testing of pharmacy staff-patient relationship quality model among BPJS patients in the Public Health Centers (PHC) Magelang Region. This type of research is quantitative correlational with cross sectional approach. The sample used was 255 respondents. The sampling method in this study was non-probability sampling with purposive sampling technique. Hypothesis testing were used Structural Equation Modeling-Partial Least Square (SEM-PLS). The results of research are interpersonal communication have a positive effect on commitment relationships and the quality of communicative relationship. (p &amp;lt;0.05). Patient participation behavior has a positive effect on the commitment relationships and the quality of communicative relationships (p &amp;lt;0.05). Pharmacy staff participation behaviour has a positive effect on the commitment relationships the quality of communicative relationships (p &amp;lt;0.05). PHC need to improve pharmacy staff clinical performance, therefore that pharmacy staff can provide services pharmaceuticals that meet the targets and standards set.&lt;/span&gt;&lt;/p&gt;

Phenomenon : Patient-centered communication is an ideal for undergraduate medical education and has been for decades. However, medical students often find the patient-centered approach challenging. The present study finds a possible discordance between formal intentions of a medical curriculum and the corresponding learning environment. The objective of our study was to explore how medical curriculum resonates with the purpose of patient-centered medicine, including how a possible dynamic may have helped maintain this discordance in undergraduate medical education. Approach : The study took a qualitative approach exploring the medical curriculum via a structured communication course. The educational context for the course was considered a discursive environment, partially constructed through documents. The concept of textual agency was used to analyze curriculum and course documents. This was to explore how competencies were presented in the medical curriculum and course descriptions and how they were translated through the practices of the communication course. Inductive thematic analysis was used to analyze observations made during the course. Findings : Our analysis suggested that the medical curriculum content and structure still emphasize bio-medical disciplines and knowledge domains in students learning. This connected well with the socialization of medical students toward the role as medical experts whose primary task is to provide information, while patients are defined as passive subjects, who received information. The course description also operationalized complexities of patient-centered communication to a measurable, instrumental structure of skills. This focus on one-directional communication frames the students’ understanding of the courses and their performance in it. They learn that: (1) meeting a real patient is a rare opportunity, (2) engaging patients’ thoughts and feelings in the conversation is challenging, and (3) the biomedical aspect should be prioritized in the conversation. Insights : These findings suggested that the medical curriculum we studied gave limited room for patient-centered medicine, even in communication training. The power of macro-level documents framed and focused micro-level learning activities and could help explain observed disharmonies in patient-medical student encounters. We see how patient-centered medicine – in both texts and practice – is represented and enacted as a peripheral activity and patients are given a marginal position in encounters with students. The findings suggested that there are challenges for progress and change toward a more patient-centered communication training and curriculum. However, empirical findings also offered points of departure for course leaders and curriculum planners wishing to take steps toward a stronger and more reflective patient-centered approach in medical education, supported through the document structure and the translation of the curriculum through relevant learning activities.