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

Abstract

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 towards patient-centredness and examine validity of the 18-item Patient–Practitioner Orientation Scale (PPOS) in this context.Participants/setting430 medical students in years 1, 3, 5 and 6 of a 6-year medical training programme in Bamako, Mali.DesignWe conducted a cross-sectional survey, compared the proportion of students who agreed with each PPOS item by gender and academic year, and calculated composite PPOS scores. To examine psychometrics of the PPOS and its two subscales (‘sharing’ and ‘caring’), we calculated internal consistency (Cronbach’s alpha) and performed confirmatory and exploratory factor analyses (CFA and EFA).ResultsIn seven of the nine ‘sharing’ items, the majority of students held attitudes favouring a provider-dominant style. For five of the nine ‘caring’ items, the majority of student responded consistently with patient-centred attitudes, while in the other four, responses indicated a disease-centred orientation. In eight items, a greater proportion of fifth/sixth year students held patient-centred attitudes as compared with first year students; there were few gender differences. Average PPOS scores indicated students were moderately patient-centred, with more favourable attitudes towards the ‘caring’ aspect than ‘sharing’. Internal consistency of the PPOS was inadequate for the full scale (α=0.58) and subscales (‘sharing’ α=0.37; ‘caring’ α=0.48). CFA did not support the original PPOS factors and EFA did not identify an improved structure.ConclusionsWest African medical students training in Bamako are moderately patient-centred and do not show the same declines in patient-centred attitudes in higher academic years as seen in other settings. Medical students may benefit from training in shared power skills and in attending to patient lifestyle factors. Locally validated tools are needed to guide West African medical schools in fostering patient-centredness among students.

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

“…In general, Chinese medical students tended toward patient-centred attitudes, as indicated by a mean 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) medical students (Hurley et al, 2018; Ribeiro, Krupat & Amaral, 2007; Haidet et al, 2002; Ahmad et al, 2015). The Chinese medical students’ ‘Sharing’ subscales (2.88) were generally lower than Malian (3.04), Pakistani (3.18), and Brazilian (4.10) medical student scores.…”

Peer Review #2 of "Gender differences on medical students’ attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China (v0.2)"

“…(Haidet et al, 2002;Ribeiro et al, 2007;Lee et al, 2008b) In general, Chinese medical students tended toward patient-centred attitudes, as indicated by a mean 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) medical students. (Hurley et al, 2018;Ribeiro et al, 2007;Haidet et al, 2002;Ahmad et al, 2015) The Chinese medical students' 'Sharing' subscales (2.88) were generally lower than Malian (3.04), Pakistani (3.18), and Brazilian (4.10) medical student scores. However, the Chinese medical students' 'Caring' subscales (4.53) were generally lower than Brazilian students (5.20) but higher than Pakistani (3.63) and Malian (3.68) students.…”

“…It is a similar to Africa's cultures that have similarly seen higher caring scores as compared to sharing. (Lee et al, 2008b;Searight & Gafford, 2005;Tai & Tsai, 2003;Hurley et al, 2018) In China, Ting et al found that patients were more likely to rely on doctors to control consultations, decision-making, and information distribution; also, Ting et al established that patients do not think that they have the knowledge or ability to handle medical issues. (Ting et al, 2016; The higher 'Caring' subscales might be due to medical students hoping that doctor-patient relationships can be based on mutual understanding…”

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

“…A curriculum that emphasizes on biological aspects of diseases has no efficiency in institutionalizing of such attitude. The intensity of the workload and responsibilities of medical students, which can lead to burn out, is another reason (7). However, the evidence on this regard is contradictory so that some other similar studies indicate an increase or no significant change in patient-centeredness attitude during the course of study (8,9).…”