Advances in Medical Education and Practice (Jul 2016)
Student-centered tutoring as a model for patient-centeredness and empathy
Abstract
Adaya Meirovich,1 Rosalie Ber,2 Michael Moore,3 Avi Rotschild4 1Department of Management of Service Organizations, Hadassah Academic College, Jerusalem, 2Medical Education Unit, Ruth and Bruce Faculty of Medicine, 3Faculty of Education in Science & Technology, 4Department of Neonatology, Carmel Medical Center, Ruth and Bruce Faculty of Medicine, Technion, Israeli Institute of Technology, Haifa, Israel Background: Curriculum planners and medical teachers attempt to enhance medical students’ empathy and patient-centeredness. Despite educational efforts, there is stability in medical students’ empathy and patient-centered medicine during the preclinical stage and a decline in both of them throughout the clinical years. Student–tutor relationship plays a key role in students’ learning. This study tests the effect of learner-centered tutoring on students’ empathy, patient-centeredness, and behavior. Participants and methods: The cohort of 55 students was divided into groups of seven or eight. The experimental group’s tutors underwent LC mentoring. Empathy was assessed with the Jefferson Scale of Physician Empathy for Students; PC attitude was assessed with the Patient–Provider Orientation Scale (PPOS). Behavior was assessed by simulations of doctor–patient encounters with 32 students at the end of the third year. Each student participated in three such simulations, during which we analyzed ten aspects of physician–patient communication via Roter interaction analysis system (RIAS)-coded audiotapes. Results: A significant group difference was found for three RIAS categories: building a relationship and patient-centeredness, where the mean percentage of the experimental group was significantly higher than that of the control group, and gathering data, where the mean percentage of the experimental group was significantly lower than that of the control group. A significant correlation was found in the experimental group between empathy and positive talk and between PPOS and three of the RIAS categories: gathering data, psychosocial talk, and patient-centeredness. A significant negative correlation was found in the experimental group between PPOS and two of the RIAS categories: negative talk and doctor–centeredness. Two significant negative correlations were found in the control group: between empathy and patient-centeredness and PPOS and negative talk. Conclusion: The LC approach supports two of the RIAS categories, corresponding to clinical empathy and PC care and the link between certain behaviors and the PPOS. Keywords: undergraduate, medical students, teaching methods, doctor-patient relationship, medical teacher, randomized controlled trial, health professional education
