Patient-Practitioner Orientation Scale Research Articles

Innovations in Curriculum Designs Do Not Guarantee Students’ Patient-Centered Attitudes Running Title: Curricula and Patient-Centered Attitudes

ABSTRACT Background Medical schools all around the world are engaged in curricular reforms aimed at fostering patient- and learner-centeredness, implementing curricular transformations in order to counterbalance the erosion of humanistic and professional values and the loss of idealism of recent graduate physicians. In Brazil, medical schools are facing the challenge of redesigning medical curricula towards more learner-centered and patient-centered approaches, stimulated by recent national medical education guidelines. However, desirable outcomes towards medical education have not been fully achieved. Aim To access medical students’ attitudes and determine predictors of medical students’ patient-centered attitudes among students from different curricular designs (traditional, innovative and advanced). Methods Medical students from 1st to 6th year from 21 Brazilian medical schools participating in the project for evaluating change and trends proposed by the Brazilian Association of Medical Education, with different stages of curricular designs (traditional, innovative and advanced), answered the Brazilian version of the Patient–Practitioner Orientation Scale (B-PPOS) and a questionnaire with curricular and sociodemographic variables. Results Brazilian medical students care more than they share information, power and responsibility (p < 0.001; d = 0.599). They are more concerned with the psychosocial context than with patient’s perspective (p < 0.001; d = 0.797) and share more power and responsibility than understanding (p < 0.001, d = 0.455). Female gender (B = 0.180), students from public schools (B = 0.132), year of medical training (B = 0.021), preference for future medical practice in public services (B = 0.053) and extracurricular activities (B = 0.068) were predictors of patient-centered attitudes among medical students (p < 0.05). Meanwhile, the father’s educational level and choice to study surgical specialties (p < 0.05) were predictors of less patient-centered attitudes among students. Different curricular designs were not associated with students’ patient-centered attitudes (p > 0.05). Conclusion tant predictors of patient-centered attitudes among medical students. Further research should investigate the direct influence of faculty professionalism development programs on students’ patient centered-attitudes.

Impact on core values of family medicine from a 2-year Master\u2019s programme in Gezira, Sudan: observational study

BackgroundTraining of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master’s programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates’ adherence to some core values of family medicine.MethodsThis is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians’ attitude towards patient-centeredness. Practice based data from individual patients’ consultations and self-assessment methods were used to assess physicians’ adherence to core values.ResultsAt the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p < 0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients’ medical history (p < 0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007).ConclusionsThe GFMP Master’s programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.

Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China.

ObjectivesAssessing medical students’ attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform.MethodsA cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students’ attitudes. The medical students’ demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category.ResultsA total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for ‘Caring’ (including patients’ preferences into the decision-making process) than for ‘Sharing’ (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher ‘Sharing’ and ‘Caring’ subscale scores. Student category (P < 0.05) was associated with ‘Sharing’ and ‘Caring’ scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher ‘Sharing’ and ‘Caring’ subscale scores, Students without siblings (p < 0.07) were associated with the higher ‘Sharing’ subscale scores.ConclusionsIn China, gender has a significant impact on medical students’ patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.

Patient Satisfaction With Decision Making Does Not Correlate With Patient Centeredness of Surgeons

BackgroundHigh-quality decision making is important in patient-centered care. Although patient involvement in decision making varies widely, most patients desire to share in decision making. The Press-Ganey Patient Satisfaction survey includes questions that measure patients' perceptions of their providers' efforts to involve them in decision making (PGDM). We hypothesized that higher PGDM scores would correlate with higher scores on a validated measure of patient centeredness. Materials and methodsSurgical providers at a university hospital who routinely receive Press-Ganey scores received a survey that included the Patient-Practitioner Orientation Scale (PPOS), a validated tool that measures the provider's orientation toward patient centeredness on a continuous six-point scale: score ≥5 = high, 4.57-5 = moderate, and <4.57 = low and includes nine-item “caring” or “sharing” subscales. We compared PPOS scores to PGDM scores, averaged from April 2015 to January 2016. ResultsEighty-six of 112 (75%) of surgical providers responded to the survey. Fifty-two (46%) had PGDM scores available and 26% achieved a perfect score on the PGDM. The overall PPOS scores were low, with a mean of 4.2 (SD = 0.5). The PPOS was not correlated with the PGDM, correlation coefficient (rs) = −0.07 (CI: −0.34-0.21, P = 0.63). Similarly, the two subscales of the PPOS did not correlate with the PGDM with rs = −0.15 (CI: −0.41-0.13, P = 0.29) for “caring” and rs = −0.04 (CI: −0.31-0.23, P = 0.76) for “sharing”. ConclusionsAlthough surgical providers scored low in patient centeredness using the PPOS, over one-quarter (26%) of them rank in the top 1% on the PGDM. No correlation was found between providers' patient centeredness and their patients' perceptions of efforts to include them in decision making.

Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey

BackgroundPatient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students’ attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs.ObjectiveTo assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide.MethodsWe conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students’ patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores.ResultsThere were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17–58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals.ConclusionThis is the first international study assessing students’ attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.

Patient-centred orientation of students from different healthcare disciplines, their understanding of the concept and factors influencing their development as patient-centred professionals: a mixed methods study

BackgroundA patient-centred approach to care is increasingly the mandate for healthcare delivery. There is a need to explore how health professional students develop patient-centred attributes. This study aims to understand the extent of patient-centred orientations of health professional students, their perceptions and factors influencing their adoption of the approach.MethodsThe study used a cross-sectional, parallel mixed methods design combining a survey using the Patient-Practitioner Orientation Scale (PPOS) followed by focus groups with medical, nursing, physiotherapy and speech and language therapy students. Data included students’ age, gender, programme, and placements experienced. Pearson’s chi squared and the non-parametric equivalent Kruskal-Wallis H test were done to test for differences in demographics for appropriate variables. One-way ANOVA or Welch test was done to explore differences in PPOS scores. Regression analysis was done to test the influence of the demographic variables on PPOS scores. Data from focus groups were coded, categorised and organised under themes appropriate to the research aims.ResultsOf the 211 complete responses, significant differences were observed between medical and physiotherapy students in total PPOS scores, (MD -8.11 [95% CI -12.02 - 4.20] p = 0.000), Caring component (MD -4.44 [95% CI - 6.69, − 2.19] p = 0.000) and Sharing component (MD -3.67 [95% CI -6.12 -1.22] p = 0.001). The programme in which students were enrolled i.e. Medicine and SALT were the only indicators of higher PPOS total scores (F = 4.6 Df 10,69; p = 7.396e-06) and caring scores (F = 2.164 Df 10, 69 p = 0.022). Focus groups revealed that students perceived patient-centredness as holistic yet individualised care through establishing a partnership with patient. They identified that their student status, placement pressures, placement characteristics especially mentoring influenced their development of patient-centred attributes.ConclusionThis study highlights the fact that the pressures of training in the National Health Service affects the development of students’ patient-centred orientation. There is a need for further work to explore aspects related to mentor training, for the development of patient-centred attributes, in a curricular framework structured on students’ needs from this study.

Practitioners' positive attitudes promote shared decision-making in mental health care.

There is a growing expectation of implementing shared decision making (SDM) in today's health care service, including mental health care. Traditional understanding of SDM may be too narrow to capture the complexity of treatments of mental health problems. Although the patients' contribution to SDM is well described, the contribution from the health care practitioners is less explored. Therefore, our aim was to explore the attitudes of practitioners in mental health care and the associations between practitioners' attitudes and SDM. We performed a cross-sectional study where practitioners reported their sharing and caring attitudes on the Patient-Practitioner Orientation Scale (PPOS) and age, gender, profession, and clinical working site. The patients reported SDM using the CollaboRate tool. We used a mixed effect model linking the data from each practitioner to one or more patients. We presented the findings and used them as background for a more philosophic reflection. We included 312 practitioners with mean age 46.1years. Of the practitioners, 60 held a medical doctors degree, 97 were psychologists, and 127 held a college degree in nursing, social science, or pedagogy. Female practitioners reported higher sharing (4.79 vs 4.67 [range 1-6], P=.04) and caring scores (4.77 vs 4.65 [range 1-6], P=.02) than males. The regression model contained 206 practitioners and 772 patients. We found a higher probability for the patient to report high SDM score if the practitioner reported higher sharing scores, and lower probability if the practitioner worked in ambulatory care. SDM in mental health care is complex and demands multifaceted preparations from practitioners as well as patients. The practitioners' attitudes are not sufficiently explored using one instrument. The positive association between practitioners' patient-centred attitudes and SDM found in this study implies a relevance of the practitioners' attitudes for accomplishment of SDM processes in mental health care.

Does Patient-Centered Attitude Improve During Internship? A Longitudinal Study

Background The patient-centered approach improves the quality of health care. Promoting this approach will increase the patients’ satisfaction and improve interpersonal skills among health care providers. Objectives The aim of the current study was to compare the viewpoints of interns toward the patient-centered approach in the beginning and the end of the internship at the Kerman University of Medical Sciences (KUMS). Methods This longitudinal study was carried out at KUMS between March 2017 and July 2018. All medical students who had passed the internship entrance exam were selected through a census. The Persian version of the patient-practitioner orientation scale (PPOS) was completed at the start and the end of the internship. This instrument has 18 items in two 9-item subscales: sharing and caring. The minimum and maximum scores were 1 to 6, respectively. The higher the score, the more the patient-centered orientation. The data were analyzed by SPSS using independent and paired -tests, ANOVA, and multiple linear regression. Results The mean scores of PPOS were 3.92 ± 0.42 and 3.86 ± 0.37 at the beginning and the end of the internship, respectively. This difference was not statistically significant. The mean score of the caring subscale significantly increased during internship but no significant change was found in the mean score of the sharing subscale. Conclusions The results of our study showed that the patient-centered attitude toward patient caring improved during the internship in the majority of interns but no significant improvement was found in terms of patient sharing. Significant progress can be made in the quality of physician-patient communication and patient satisfaction if necessary training programs are run on patient-centeredness.

Perceptions of physicians, medical and nursing students concerning shared decision-making: a cross-sectional study

ABSTRACT Objective: The purpose of this study was to evaluate the attitudes of Flemish physicians and medical/nursing trainees regarding shared decision-making (SDM) and to determine possible differences based on sex, age, rank, occupation and specialty. Methods: A cross-sectional study was conducted between June and September 2017 in which the Patient-Practitioner Orientation Scale (PPOS) was translated and administered. Higher scores on the six-point scale indicate a patient-centered respondent. Independent t-tests, One and Two-way ANOVA and multivariate regression analysis with the variables sex, age, occupation and specialty were performed. Results: 266 responses from 93 physicians, 147 medical and 26 nursing students were analyzed. Mean sharing scores were 4,24 ± 0,64; 4,30 ± 0,61; and 4,30 ± 0,67, respectively. In the regression model, female sex (p < 0,10) and employment (p < 0,05) in general practice or internal medicine is predictive for higher sharing among physicians. Bivariate analysis revealed significant differences between specialisms (p < 0,05): pediatricians (4,79 ± 0,69), psychiatrists (4,74 ± 0,47), obstetricians/gynecologists (4,40 ± 0,38) and general practitioners (4,31 ± 0,59) scored higher on the PPOS than surgeons (3,84 ± 0,58). Conclusion: Flemish providers and trainees are disease-centered. Physicians’ attitudes vary depending on their specialism, presumably due to prolonged exposure to the specific clinical context. Additionally, academic-trained nurses share the belief that the physician should decide and the patient should rely on his knowledge rather than his own. There is an urgent need for health policy and educational institutions to facilitate an environment in which SDM is supported.

Medical Students' Perceptions of the Doctor-Patient Relationship: A Cross-Sectional Study from Saudi Arabia.

IntroductionThe physician-patient relationship is at the heart of the art of medicine. Patient-centered care is rapidly evolving as the standard of care as well as the optimal vehicle to achieve high-quality healthcare and good clinical outcomes. This study aims to examine the attitudes of pre-clinical (third-year) students from Alfaisal University (Riyadh, Saudi Arabia) toward the physician-patient relationship.MethodsThis cross-sectional study took place during the spring 2017 academic year. All third-year students (n=210) were requested to voluntarily complete an online and anonymous questionnaire. The questionnaire covered students’ demographical characteristics (gender, nationality, and cumulative grade point average) and their response to a previously validated instrument, the Patient-Practitioner Orientation Scale (PPOS), which explores the attitudes of medical students toward the doctor-patient relationship.ResultsIn total, 132 students participated in the survey (n=132/210) with an overall response rate of 62.9%. Most respondents were female (56.8%), non-Saudi citizens (53.0%), and high achievers (70.5%). Most of the mean scores on the PPOS statements indicated patient-centered attitudes - that is, mean scores were higher than “3”. The mean score for the overall PPOS was 4.0 ± 1.5, whereas the mean scores for the sharing and caring domains were 4.2 ± 1.5 and 3.8 ± 1.4, respectively. Univariate correlations between the students’ demographics and their mean scores for the sharing domain, caring domain, and overall PPOS showed no statistically significant differences (p > 0.05).ConclusionThe pre-clinical medical students showed favorable patient-centered attitudes. There were no statistically significant differences between students’ demographics (gender, nationality, and academic performance) and PPOS scores (sharing domain, caring domain and overall score).

Perception of doctor-patient relationship among undergraduate medical students in a medical college of West Bengal

Background: Doctor-patient relationship is the central pillar of medical care, which affects patients’ psychological, social and biological outcomes. Medical undergraduate students need to develop one to one relationship with patients. The objective of the present study was to assess the sharing and caring dimensions of the doctor-patient relationship using the Patient-Practitioner Orientation Scale (PPOS) and to analyze any difference across the demographic characteristics, of the undergraduate's medical students. Materials & Methodology: We did an observational descriptive cross-sectional study in a tertiary medical college of West Bengal. We used one to one interview technique as a study technique using an interview schedule consisting of sociodemographic characteristics, patient-practitioner orientation scale (PPOS). Results: Male participants constituted 59%, that is 133, whereas females were 93 (41%). Mean PPOS score was 3+0.62, Mean sharing score was 3+0.63, mean caring score was 3+0.61. Results showed significant difference across gender where female scored higher in mean sharing (2.99+0.61 vs 3.35+0.63), caring (2.82+0.58 vs 3.02+.70) & total PPOS score compared to males (2.90+0.58 vs 3.1+0.67) (p=0.00). Students from the urban locality had a significantly higher score in sharing (3.16+0.64 vs 2.92+0.49), and the total score (3.04+0.66 vs2.87+0.51) compared to rural students. Conclusions: This study gave the idea about the perception of the doctor-patient relationship among medical students of a Medical college of West Bengal. Keeping in mind this baseline score, we suggested strategies to improve doctor-patient relationships. Various teaching leaning tools could be incorporated, and contextualised case-scenarios and role plays could be framed so that proper relationship could be built.

Patient-Doctor relationship in underserved environment: A cross-sectional study of attitudinal orientation, practice inclination, barriers and benefits among medical practitioners in Abia State, Nigeria.

Healthcare has become complex requiring balance of ever-increasing demands on physicians against humanness of medicine. As the impetus for the delivery of patient-centred care grows, there is need to study the attitude and practice orientations of medical practitioners to patient-doctor relationship (PDR). The study was aimed at describing the attitude, practice, barriers and benefits of PDR among medical practitioners in Abia State. A descriptive cross-sectional study was carried out on 210 medical practitioners in Abia State who were consecutively recruited for the study. Data were collected using self-administered questionnaire that elicited information on attitude, practice, barriers and benefits of PDR. Attitude was assessed with the 18-item Patient-Practitioner Orientation Scale (PPOS) with subscales of caring and sharing. The age of the participants ranged from 26 to 77 years with the mean of 36 ± 8.4 years. There were 173 (82.4%) male. The caring attitude score (mean = 3.57 ± 0.80) was higher than sharing (mean = 3.42 ± 0.65) (P = 0.036). Practice was predominantly doctor-centred (86.7%) than patient-centred (64.3%, P < 0.0001). The most common barrier to PDR was patient-doctor communication, while the most common benefit of PDR was improvement in patient satisfaction. Medical practitioners with duration of practice <10 years had significantly higher mean scores in attitudinal subscale of caring when compared with those with duration of practice ≥10 years (P < 0.0001). The study participants with duration of practice ≥10 years had significantly higher adequate practice (75.0%) of patient-centred care when compared with their counterparts with duration of practice <10 years (47.6%) (P = 0.00005). The attitude to caring did not translate to comparative disposition to sharing. The practice was more doctor-centred than patient-centred. The most common barrier and benefit of PDR were communication drawbacks and improvement in patient satisfaction, respectively. Duration of practice was associated with caring attitude and practice of patient-centred care, respectively.

Attitudes Toward Patient-Centered Care in the Mental Care Services in Isfahan, Iran.

Understanding patient-physician relationships in mental care services is an indispensable element to improve the quality of mental care, yet little is known about it in Iran. This study measured the attitudes of the patients' family and personal caregivers (FPCs) and psychiatrists toward patient-centered care. A sample of 88 FPCs of mental patients and 29 psychiatrists in four teaching hospitals of Isfahan city, Iran, providing mental care, were asked to complete the patient-practitioner orientation scale (PPOS). Results showed mean scores of PPOS, sharing and caring for the psychiatrists were 3.4, 3.8, and 3.1, compared to 3.9, 4.2, and 3.7 for the mental patients' FPCs. There was a significant difference between the PPOS mean scores of the FPC and psychiatrist groups (p < 0.05) indicating that psychiatrists' attitudes were less patient-centered. Developing medical training interventions, establishing communication skills workshops, and increasing patients' awareness are some approaches to address the low level of patient-centered care.

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

The Impact of Limited Cancer Health Literacy on Patient Preference for Shared Care

Background: Patient are increasingly expected to engage in their own care. However, patients with limited health literacy often struggle with this. The expectation of patients' engagement in health care decisions by their healthcare providers likely increases the burden that cancer patients are already experiencing following a life-changing diagnosis. Involving patients with cancer in medical decision-making requires them to have an adequate understanding their disease and treatment options. Limited health literacy poses a barrier to patient engagement in their own care, contributing to health disparities and poorer cancer outcomes. Aim: Our primary objective was to determine levels of health literacy among patients with cancer and the extent of its association with patient preference for care. We also sought to identify sociodemographic and clinical characteristics associated with limited cancer health literacy. Methods: As part of a larger prospective cohort study, N = 345 adult cancer patients attending a large, university-affiliated outpatient oncology clinic were recruited using consecutive sampling. Face to face interviews were conducted using questionnaires. Instruments used included the 30-item Cancer Health Literacy Test (CHLT-30), and the Patient-Practitioner Orientation Scale (PPOS) to determine patient preference for shared care. The relationship between cancer health literacy and patient preference for shared care was examined using bivariate analysis, with logistic regression used to identify predictors. Results: Mean patient age was 60.0 ± 11.6 years. A greater female preponderance was observed (69.4%), with over half of patients indicating secondary school completion (51.6%). Up to 79.3% of patients reported a monthly household income of less than RM 4000 (approximately USD 1000), placing them in the bottom 40% of household incomes in Malaysia. A total of 59.1% of patients (n = 204) in this sample were found to have limited cancer health literacy, with an average score of 14.40 ± 4.04 out of a full score of 30. Patients with limited cancer literacy were 1.69 times (95% CI 1.42-2.03) less likely to prefer active participation in their care. Conclusion: Rates of limited cancer literacy in this sample (59.1%) appear to be at least three times higher than prevailing rates in high resource countries with established cancer control programs such as the United States (18%). One out of every two patients with cancer in this study were found to possess limited health literacy, making this a significant issue particularly given its association with lesser patient preference for shared care. This study marks an important first step toward increasing health literacy among patients with cancer and empowering patients to participate in their care, which may help mitigate the impact of disparities such as lower educational and socioeconomic levels traditionally associated with poorer cancer outcomes.

TF-9 A Medical Humanities Curriculum for Emergency Medicine Residents

Humanities curricula for medical students have been shown to improve observation skills, empathy, wellness, and tolerance of uncertainty. Such attributes are all the more important in residency training; however, formal implementation and evaluation of similar curricula are lacking in graduate medical education (GME), especially in emergency medicine (EM). EM residency training demands excellent observation and communication skills, ability to practice patient-centered care, and development of skills to cope with stress and uncertainty; humanities curricula may therefore be of specific value for EM residents. This multimodal medical humanities curriculum incorporates themes relevant to EM and comprises museum visits, self-instructional modules, and classroom discussions. The goal of this curriculum is to use visual thinking strategies and narrative medicine to enhance resident observation and communication skills, patient-centeredness, empathy, and wellness. Upon curriculum completion, residents will improve their ability to 1) evaluate impact of personal biases and develop a patient-centered, empathetic approach, 2) demonstrate comfort with ambiguity, 3) make and communicate thoughtful and thorough observations, and 4) develop strategies to mitigate burn-out and address challenging situations. This longitudinal curriculum for EM residents in any year of training is to be implemented over 6 months during weekly protected conference time. In session 1, residents will be introduced to visual thinking strategies at a local museum and assigned a “portrait patient” to follow longitudinally during the curriculum. Three subsequent sessions will be small-group discussions using relevant extracts of novels, short stories, and nonfiction articles and residents’ written responses to the readings to focus on themes of 1) the patient experience, 2) medical conundrums and the art of diagnosis, and 3) the role of the physician in disaster settings. An additional classroom session on the clinical gaze and its correlations in visual arts will serve as a point of synthesis for prior sessions. The curriculum will conclude with a case study-based discussion of ethical dilemmas, which will permit residents to synthesize themes from previous sessions and practice consensus-building and communication skills. A pre- and post-course evaluation will use validated scales to assess curriculum impact on empathy (Jefferson Scale of Empathy), patient-centeredness (Patient-Practitioner Orientation Scale), tolerance of ambiguity (Tolerance of Ambiguity Scale) and burnout (Shirom-Melamed Burnout Measure). Residents will also provide written observations of a set of images, which will be scored for complexity and length. The post-survey will include an evaluation of resident satisfaction with the course and free-text response about potential strategies to mitigate burnout that they may have gleaned from this course. Residents’ ability to analyze, interpret, and communicate observations about visual and written data will be assessed via discussion participation and written responses to readings. If demonstrated to be feasible and if shown to have a positive impact on key resident attributes, this portable and adaptable curriculum could serve as a model not only for other EM residency programs, but for other GME specialties.

Association of burnout with doctor-patient relationship and common stressors among postgraduate trainees and house officers in Lahore-a cross-sectional study.

IntroductionBurnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor–patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor–patient relationship.MethodsA descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or “HOs” (recent graduates doing their 1 year long internship) and post-graduate trainees or “PGRs” (residents for 4–5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor–patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21.ResultsA total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS (P > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson’s burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income.ConclusionAlthough burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor–patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced.

Medical Students' Perception towards Doctor‐Patient Relationship: A Cross‐Sectional Study at AlFaisal University

IntroductionStrengthening the relationship between a doctor and a patient is an essential element for a advancing a healthcare system. As previous studies have ubiquitously demonstrated this phenomenon, studying the perception of medical students towards this relationship in one of the developing countries is highly important. The perception is measured by Patient ‐ Practitioner Orientation Scale (PPOS) which contains both caring items, assessing how much care provided to your patients and sharing items, which reflect the amount of information shared with patients. As PPOS score increases, the practice becomes more towards patient – centeredness and hence, more coherence in doctor‐patient relationship.MethodA total of 132 third year medical students at Alfaisal University were enrolled in this cross sectional study. The quantitative questionnaire was carried out using Patient‐ Practitioner Orientation Scale (PPOS). The overall scores of patient caring and sharing were calculated and the statistical difference was assessed using the independent samples t‐test. The effect of various factors including gender and academic level (measured by GPA) was measured using independent samples t‐test and one‐way multiple variance of analysis (ANOVA), respectively. The linear regression model was also utilized to determine whether these factors predict the caring, sharing and the overall PPOS scores.ResultsThe mean scores of caring, sharing and overall PPOS were 4.21, 3.98 and 4.10, respectively. Students have demonstrated higher scoring in caring items compared to sharing ones (P&lt;0.01). Male students have scored more in sharing components compared to their female peers (4.20 vs. 3.81, P&lt;0.01). In addition, students with good GPA rated higher in caring items than those with average GPA (P&lt;0.05). None of the factors have really predicted the caring, sharing and overall PPOS scores.ConclusionOur findings suggest that our students' perception towards patient‐centeredness was lower than previous studies and more education along with practice are required to improve this attitude. Moreover, students had lower perception towards the importance of sharing adequate information with the patient, an attitude that needs to be further rectified in order to enhance the advancement of healthcare system in Saudi Arabia.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Patient-centred attitudes among medical students in Mali, West Africa: a cross-sectional study

Background/objectivePatient-centred attitudes have been shown to decline during medical training in high-income countries, yet little is known about attitudes among West African medical students. We sought to measure student attitudes...

Patient-centred hearing care in Malaysia: what do audiologists prefer and to what extent is it implemented in practice?

ABSTRACTObjectives: The preferences and practices of audiologists in Malaysia towards patient-centred care (PCC) in audiological management of adult patients was investigated using a sequential mixed-method study design.Method: In Phase 1, the Patient-Practitioner Orientation Scale questionnaire (PPOS) investigated audiologists’ preferred extent of control and authority over adult patients in audiological management. In Phase 2, individual semi-structured interviews explored the nature of patient-centred hearing care. A total of 111 audiologists (mean age = 29.77 years, SD = 4.34) were involved in Phase 1; and eight audiologists (mean age = 28.9 years, SD = 3.76) were involved in Phase 2.Results: The overall PPOS score (M = 3.95, SD = 0.10) indicated that the audiologists preferred patient-centred audiological management for their adult patients. However, further analysis revealed that audiologists preferred to lead discussions and be in control of appointment sessions. Findings from the interviews revealed the focus of audiological management was on addressing patients’ biomedical needs, with hearing aids being the only rehabilitation option offered. Furthermore, while the audiologists encouraged patients’ families to be involved in audiological management, the families were mainly given a passive role in the patients’ rehabilitation.Conclusion: In general, despite audiologists in Malaysia having positive attitudes towards PCC in audiological management, their practice was typically clinician-centred and biomedically focused.