The Impact of a “Doctor-Patient Relationship” Discipline on Patient-Centred Attitudes

<p></p><p>ABSTRACT Several studies have demonstrated that medical students’ attitudes toward patient-centred care tend to decline throughout undergraduate education. At present, the adequate translation of the communication skills among medical students into clinical practice remains a challenge. Regardless of the increased efforts of educators to improve the provision of patient care, learning to communicate as a professional physician remains a complex process. Objectives To evaluate the impact of the “doctor-patient relationship” discipline on medical students’ attitudes towards patient-centred care, and to examine whether variables related to demographic characteristics and different stages of education are associated to medical student’s patient-centred attitudes. Methods Two-hundred and seventy nine medical students who responded a Patient-Practitioner Orientation Scale (PPOS), a validated instrument exploring attitudes towards the doctor-patient relationship were enrolled: 128 (45.9%) who attended the “Doctor-Patient Relationship” discipline and 151 (54.1%) volunteer students, matched by sex and age, who have not taken the discipline. Multiple linear regression analyses were used to quantify the independent association between PPOS scores (overall PPOS, ‘sharing’ and ‘caring’ dimensions), demographic variables and year of medical school. Logistic models were created to quantify the independent association between the “doctor-patient relationship” discipline and PPOS and the sub-scales scores. Results In the linear regression analysis, female gender (p ≤ 0.01), older age (p ≤ 0.02) and earliest years of medical school (p ≤ 0.02) were significantly associated with more patient-centred attitudes. Higher score on the ‘sharing’ sub-scale was independently associated with attending the “doctor-patient relationship” discipline (4.50 ± 0.65 for those who have studied the discipline vs. 4.33 ± 0.65 for those who have not studied the discipline, p = 0.03) after adjustment, in logistic models, for student’s age, gender and years on the medical course. Medical educators should be focused on innovative strategies that stimulate humanistic attitudes, improve communication skills and truly change medical students’ behaviour towards patient-centred care.</p><p></p

Histological comparison of antral and corpus gastric mucosa of <i>H. pylori (HP)</i>-positive (n = 47) and -negative (n = 78) children^a.

a<p>One antral and 3 corpus gastric biopsy specimens from <i>HP</i>-positive and 7 antral and 1 corpus biopsy specimens from <i>HP</i>-negative children were deemed to be inadequate for histology assessment; n, number.</p><p>Neither atrophy, nor intestinal metaplasia was observed.</p

<i>IL1B</i>-31, <i>IL1RN</i> and <i>TNFA</i>-307 genotypic frequencies in <i>H. pylori-positive</i> (n = 47) and –<i>negative</i> children (n = 78).

a<p>It was not possible to genotype 1 <i>H. pylori</i>-positive children for <i>IL1B-</i>31 and 1 for <i>IL1RN</i>.</p>b<p>1 indicates all the long alleles and 2 the short allele. The loci did not deviate significantly from the expected Hardy-Weinberg distribution (P = 0.90 for <i>IL1B-3</i>1, P = 0.26 for <i>IL1RN</i> and P = 0.08 for <i>TNFA</i>-307) and all segregated independently.</p

Box plots representing the comparison of gastric IL-1β (A) and TNF-α (B) concentrations (pg/mg of protein) between <i>H. pylori</i>-positive (HP+, n = 47) and -negative (HP-, n = 78) children, and between antral and corpus concentration in <i>H. pylori</i>-positive and -negative groups.

<p>The upper and lower limits of the boxes represent the 75^th and 25^th percentiles, respectively. The horizontal bar across the box indicates the median and the capped bars indicate the minimum and maximum data values. Statistical analysis by Student’s t test after log transformation in the case of IL-1β; *p<0.001 and **p = 0.02.</p

Correlations between corpus IL-1β concentrations and concentrations of ferritin and haemoglobin in <i>H. pylori</i>-positive children (n = 47).

<p>Statistical analysis by Pearson’s correlation after log transformation in the case of IL-1β and ferritin.</p

Histological comparison of antral (n = 85) and corpus (n = 83) gastric mucosa of <i>H. pylori (HP)</i>-positive children and antral (n = 202) and corpus (n = 214) gastric mucosa of <i>H. pylori</i>-negative children.^*.

*<p>Twenty-four antral and 13 corpus gastric biopsy specimens were deemed to be inadequate for histology assessment. n, number.</p

Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender, country of birth and <i>H. pylori</i> infection as independent variables in children from United Kingdom, Chile and Brazil (n = 311).

<p>Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender, country of birth and <i>H. pylori</i> infection as independent variables in children from United Kingdom, Chile and Brazil (n = 311).</p

Comparison of the iron deficiency/iron deficiency anaemia parameters between <i>H. pylori</i>-positive (n = 86) and negative (n = 225) children from Brazil, Chile and United Kingdom.

*<p>obtained by dividing the serum iron concentration by the total iron binding capacity;</p><p>SD, standard deviation; MCV, mean corpuscular volume; MCH, mean corpuscular haemoglobin.</p

Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender, country of birth and <i>H. pylori</i> infection as independent variables in children from Chile (n = 105) and Brazil (n = 125).

<p>Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender, country of birth and <i>H. pylori</i> infection as independent variables in children from Chile (n = 105) and Brazil (n = 125).</p

Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender and <i>H. pylori</i> (HP) infection as independent variables in children from United Kingdom (n = 81), Chile (n = 105) and Brazil (n = 125).

<p>Multiple linear regression models including ferritin or haemoglobin as dependent variables and age, gender and <i>H. pylori</i> (HP) infection as independent variables in children from United Kingdom (n = 81), Chile (n = 105) and Brazil (n = 125).</p