Brazilian medical students’ attitudes towards patient-centered care

Abstract

Background: The doctor-patient relationship is essencial to medical care (Engel 1980;Balint 1984), however, medical schools focus mainly on biomedical subjects and don't give the necessary attention to communication skills, humanistic attitudes, and professional values (Haidet et al. 2001(Haidet et al. , 2002. Methods: Attitudes of medical students towards the doctor-patient relationship have been examined and the Patient-Practitioner Orientation Scale (PPOS) has been used to measure students' and practitioners' patient-centered beliefs, first in USA (Haidet et al. 2002), and then in several other countries (Choi & Moon 2005;Tsimtsiou et al. 2005;Shankar et al. 2006). This study aimed to examine the attitudes of Brazilian medical students towards the doctor-patient relationship by using the PPOS. The scale was translated into Portuguese and was administered to approximately 800 students in their first, fifth, seventh, ninth, tenth and twelfth semesters of medical school along with a socio-demographic questionnaire. Results: A total of 738 students (>90%) completed data collection. For the entire cohort, female gender (p < 0.000), later semester in medical school (p < 0.000), primary-care specialty choice (p < 0.02) and lower familial income (p < 0.03) were significantly associated with more patient-centered attitudes. Sharing sub-scores, measuring beliefs about power and information between physician and patient, were significantly more patient-centered for twelfth semester male students than for first semester males (p < 0.000), but not for female students. Caring sub-scores, which measure beliefs about attending to patient's emotions and lifestyle, did not change with the years of school. In general, Caring scores were considerably higher than Sharing scores. Total PPOS scores in Brazil are comparable to those found among medical students in the United States, however they are considerably higher than PPOS total scores in Nepal, Greece, and Korea. Conclusions: Communication skills and patient care needs to be critically examined by Brazilian teachers and students aiming to change attitudes toward the doctor-patient relationship to be more patient-centered attitudes.

Impacto da “Disciplina Relação Médico-Paciente” sobre Atitudes Centradas no Paciente

“…Students at the beginning of last year have already completed six months of emergency medicine, three months of ambulatory practice at small villages and three months of internal medicine, surgery or paediatrics at University Hospital wards. Three hundred and twenty students enter college per year and all of them experienced identical curricula because there were no important curricular changes at this institution in the period of this study 16 .…”

“…These students were enrolled via internet after providing consent for participation through a web-based survey. Student attitudes regarding the relationship between physicians and patients were measured using a previously validated instrument 2,3,15,16 . The Patient-Practitioner Orientation scale (PPOS) is an 18-item instrument originally designed to be administered to either doctor or patients.…”

“…In this way, several medical schools advocate the teaching of these skills and their evaluation as a fundamental factor in medical training [13][14][15][16] . Medical schools have not only an opportunity but also a responsibility to teach and evaluate the skills of communication and the effectiveness of the doctor-patient relationship of their students.…”

“…Actually, several attitudes regarding the doctor-patient relationship are transmitted to the students by professors, tutors and other staff's members 5,8,16 . Conversely, these attitudes are not analysed during the progress through medical school.…”

“…Conversely, these attitudes are not analysed during the progress through medical school. The medical students must be stimulated to develop a critical own view toward the attitudes and communicative skills linked to the provision of patient care 6,16 . Educational strategies that encourage the examination of these attitudes and behaviours might result in the better understanding of the lapses of the doctor-patient relationship [5][6][7][8][9][10] .…”