Academic Medicine

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Academic Medicine:
doi: 10.1097/ACM.0b013e31819fa92d
Students' Values

Can Changes in the Principal Clinical Year Prevent the Erosion of Students' Patient-Centered Beliefs?

Krupat, Edward PhD; Pelletier, Stephen PhD; Alexander, Erik K. MD; Hirsh, David MD; Ogur, Barbara MD; Schwartzstein, Richard MD

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Abstract

Purpose: The third year of medical school, in which students traditionally receive their first immersion into hospital-based clinical medicine, often results in a degradation of attitudes toward medicine and patient care. The authors present data collected in the 2005–2006 academic year from a pilot program aimed at enhancing this experience, thereby enabling students to resist these negative influences.

Method: Thirty-two Harvard Medical School students, who spent their entire principal clinical experience (PCE) at one of three clinical sites (PCE group), completed the Patient-Practitioner Orientation Scale (PPOS), a measure of patient-centered attitudes, at the beginning of the year. They completed the PPOS again at year's end as well as the Community, Curriculum, and Culture (C3) hidden curriculum measure of patient-centered clinical experiences. Their responses on these measures were compared with those of a traditional-rotation control group that moved from site to site.

Results: At the beginning of the year, no PPOS differences were found within PCE groups or between PCE and control students. Traditional students' attitudes became significantly less patient-centered at year's end, whereas PCE students' attitudes did not change. PCE students reported more support for their patient-centered behaviors, and, across all students, C3 scores and changes in PPOS scores were significantly correlated.

Conclusions: Innovations in clinical education may help inoculate medical students against the degradation of attitudes. Although this research was a test of a small pilot program, the consistent pattern of findings across those clinical sites and educational models studied provides suggestive evidence that the oft-cited negative impacts of the principal clinical year are not inevitable.

© 2009 Association of American Medical Colleges

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