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

Rohani, Ali Akbar; Ebrahimi, Reyhaneh; Ahmadipour, Habibeh

doi:10.5812/sdme.85239

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

Document Type : Original Article

Authors

Ali Akbar Rohani ¹

Reyhaneh Ebrahimi ²

Habibeh Ahmadipour ³

¹ Department of Community and Family Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

² School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

³ Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

https://doi.org/10.5812/sdme.85239

Abstract

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.

Keywords

Medical Student

Patient-Centeredness

Attitude

Internship

Dancet EA, Nelen WL, Sermeus W, De Leeuw L, Kremer JA, D’Hooghe TM. The patients’ perspective on fertility care: A systematic review. Hum Reprod Update. 2010;16(5):467–87. doi:10.1093/humupd/dmq004. [PubMed: 20223789].
Scholl I, Zill JM, Harter M, Dirmaier J. An integrative model of patient-centeredness - a systematic review and concept analysis. PLoS One. 2014;9(9). e107828. doi: 10.1371/journal.pone.0107828. [PubMed:25229640]. [PubMed Central: PMC4168256].
Zill JM, Scholl I, Harter M, Dirmaier J. Evaluation of dimensions and measurement scales in patient-centeredness. Patient Prefer Adherence. 2013;7:345–51. doi: 10.2147/PPA.S42759. [PubMed:23723692]. [PubMed Central: PMC3666547].
Bombeke K, Symons L, Debaene L, De Winter B, Schol S, Van Royen P. Help, I’m losing patient-centredness! Experiences of medical students and their teachers. Med Educ. 2010;44(7):662–73. doi:10.1111/j.1365-2923.2010.03627.x. [PubMed: 20636585].
Ribeiro MM, Krupat E, Amaral CF. Brazilian medical students’ attitudes towards patient-centered care. Med Teach. 2007;29(6):e204–8. doi: 10.1080/01421590701543133. [PubMed: 17922360].
Ishikawa H, Son D, Eto M, Kitamura K, Kiuchi T. Changes in patient-centered attitude and confidence in communicating with patients: A longitudinal study of resident physicians. BMC Med Educ. 2018; 18(1):20. doi: 10.1186/s12909-018-1129-y. [PubMed: 29370796]. [PubMed Central: PMC5785873].
Hurley EA, Doumbia S, Kennedy CE, Winch PJ, Roter DL, Murray SM, et al. Patient-centred attitudes among medical students in Mali, West Africa: A cross-sectional study. BMJ Open. 2018;8(1). e019224. doi:10.1136/bmjopen-2017-019224. [PubMed: 29362266]. [PubMed Central:PMC5786142].
Lee KH, Seow A, Luo N, Koh D. Attitudes towards the doctor-patient relationship: A prospective study in an Asian medical school. Med Educ. 2008;42(11):1092–9. doi: 10.1111/j.1365-2923.2008.03157.x. [PubMed: 18826401].
Wahlqvist M, Gunnarsson RK, Dahlgren G, Nordgren S. Patientcentred attitudes among medical students: Gender and work experience in health care make a difference. Med Teach. 2010;32(4):e191–8. doi: 10.3109/01421591003657451. [PubMed: 20353319].
Tsimtsiou Z, Kerasidou O, Efstathiou N, Papaharitou S, Hatzimouratidis K, Hatzichristou D. Medical students’ attitudes toward patientcentred care: A longitudinal survey. Med Educ. 2007;41(2):146–53. doi:10.1111/j.1365-2929.2006.02668.x. [PubMed: 17269947].
Mirzazadeh A, Shahi F, Jafari S, Krupat E, Jahanian E. [Comparative study of opinions of patients and clinical faculty members of babol university of medical sciences on patient-centeredness in doctorpatient relationship using patient-practitioner orientation scale]. J Babol Univ Med Sci. 2010; 12(5):19–25. Persian.
Mudiyanse RM, Pallegama RW, Jayalath T, Dharmaratne S, Krupat E. Translation and validation of patient-practitioner orientation scale in Sri Lanka. Educ Health (Abingdon). 2015;28(1):35–40. doi:10.4103/1357-6283.161847. [PubMed: 26261112].
Jalalvandi M, Sohrabi MR, Jamali A, Taghipoor Zahir A. [The association between patient-centered hidden curriculum and medical students’ communication skills]. Iran J Med Educ. 2014;13(11):920–30. Persian.
Moore L, Britten N, Lydahl D, Naldemirci O, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017; 31(4): 662–73. doi:10.1111/scs.12376. [PubMed: 27859459]. [PubMed Central: PMC5724704].
McCormack B. Person-centredness in gerontological nursing: An overview of the literature. J Clin Nurs. 2004;13(3a):31–8. doi:10.1111/j.1365-2702.2004.00924.x. [PubMed: 15028037].
McCance T, Slater P, McCormack B. Using the caring dimensions inventory as an indicator of person-centred nursing. J Clin Nurs. 2009;18(3):409–17. doi: 10.1111/j.1365-2702.2008.02466.x. [PubMed:19191988].
Wang J, Zou R, Fu H, Qian H, Yan Y, Wang F. Measuring the preference towards patient-centred communication with the Chinese-revised Patient-Practitioner Orientation Scale: A cross-sectional study among physicians and patients in clinical settings in Shanghai, China. BMJ Open. 2017;7(9). e016902. doi: 10.1136/bmjopen-2017-016902. [PubMed:28928188]. [PubMed Central: PMC5623567].
Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: The effect of doctor-patient congruence on satisfaction. Patient Educ Couns. 2000;39(1):49–59. doi: 10.1016/S0738-3991(99)00090-7. [PubMed:11013547].