Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.

Ruth Mcnair,Katharine Reid,Hannah Sloan,Leonie Griffiths

doi:10.1186/s12909-016-0689-y

Ruth Mcnair, Katharine Reid + Show 2 more

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https://doi.org/10.1186/s12909-016-0689-y

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Journal: BMC medical education	Publication Date: Jul 15, 2016
Citations: 35	License type: cc-by

Affiliation: University of Melbourne, Northern Health

Abstract

BackgroundMedical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students’ attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones.MethodsStudents at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified.ResultsStudent confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care.ConclusionsA new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

Highlights

Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education
Positive attitudes to patient centredness are often acquired through direct teaching, as well as via clinical experience and appropriate role modelling, often termed the ‘hidden curriculum’ [7]
Study purpose and research questions The purpose of this study was to compare students’ attitudes to patient centredness and their own clinical confidence as they progressed through the medical course, and to identify any differences according to their clinical placement location

Summary

Introduction

Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The aim of this study was to compare students’ attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones. Clinical confidence and patient centredness are highly prized outcomes of medical education amongst educators and consumers alike [1, 2]. These characteristics result in a capable and humane approach to holistic patient care. Haidet (2010) suggests that patient centredness “challenges prevailing professional norms”, and that non-patient centred behaviour by clinicians is the most important influence on student behaviour [9]

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