Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.

Paul S Ciechanowski,Wayne J Katon,Joan E Russo,Linda Lm Worley

doi:10.1186/1472-6920-6-3

Paul S Ciechanowski, Wayne J Katon + Show 2 more

Open Access

https://doi.org/10.1186/1472-6920-6-3

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Abstract

BackgroundPatient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty.MethodsWe determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty.ResultsPrevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness.ConclusionAssessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.

Highlights

Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties
All individuals are characterized by one of four predominant relationship styles derived from attachment theory: "secure", "cautious", "supportseeking" and "self-reliant" [17]
For condition 1, we used logistic regression analysis with the outcome being a match in a non-primary care (1) versus primary care (0) specialty, and the predictor being the four categorized relationship style groups with the secure style group as the reference group

Summary

Introduction

Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and matching in a primary care specialty. Medical schools work diligently to help prospective resident trainees make the best specialty choice by providing a variety of assessment and informational resources, including tools assessing personality traits [3,4,5]. Attachment theory plays an important role in personality development [7] and is rapidly becoming an important construct for understanding interpersonal aspects of medical care, the patient-provider relationship [8,9,10,11] and provider behavior [12,13,14,15]. We have used the current names for the latter three attachment styles as an effort to make the concept of attachment styles as accessible as possible to educators who are counseling students or residents, and for facilitating use by clinicians for the purposes of counseling with patients, or for self-reflection.)

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