Caution profile and driving record of undergraduate males

With a device called an Apprehension Meter, 60 undergraduate males watched a 5-min film of highway driving as seen from the driver's seat and recorded a moment-by-moment judgment of degree of danger, or caution level. From responses to six discrete hazards and to intervening uneventful periods, several summary scores were derived of which five differentiated significantly by driving record. The Safe Record group remained more cautious during the uneventful (baseline) periods, reacted to hazards sooner but more gradually, relaxed more gradually after their disappearance, and consequently remained alert to each hazard longer. The Violations group were at the other extreme, and the Accidents group intermediate. Hence the Safe group appeared more prompt in detecting danger, but less abrupt in responding to it, than did the groups with infractions. In terms of consistency across six hazards or 10 baselines, reliability (Cronbach's alpha) ranged from 0.48 to 0.99. A composite caution index had an alpha of 0.85 across hazards and correctly classified 77 per cent of subjects as either safe or non-safe. The results were found consistent with those in other studies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22284/1/0000724.pd

Discrepancy in patient-rated and oncologist-rated performance status on depression and anxiety in cancer: a prospective study protocol

Objective: Psychological distress is common in patients with cancer. We need a rapid means of screening for and identifying depression and anxiety in patients with cancer. The present study evaluates the potential of the Eastern Cooperative Oncology Group (ECOG) performance status (PS) scoring as a brief screening tool to assess psychological distress in routine cancer care. The ECOG PS is widely used by oncologists and the WHO, as a standardised measure to assess general well-being in patients with cancer and quality of life in cancer trials. We examine the discrepancy between patient-rated and oncologist-rated PS scores on the ECOG in a comparative assessment against the Hospital Anxiety and Depression Scale (HADS). Methods and design: This is a prospective evaluation of approximately 500 ambulatory adult cancer patients from a large academic medical centre. Participants will be asked to assess their own ECOG PS on a scale of 0–4, which will be compared to ECOG PS as rated by their oncologists. Higher ECOG PS scores indicate poorer daily functioning. Both patient-rated and oncologist-rated ECOG PS and their absolute differences will be tested for predictive and concurrent validity against the HADS. A HADS cut-off ≥15 will be used. Ethics approval for this study has been secured from the institutional ethics board. Outcomes are re-evaluated at 4-week to 6-week and 1-year follow-up. Conclusion: This study holds practical significance for rapid screening of psychological distress in the cancer clinic with the use of the ECOG PS scoring. Given the high prevalence of anxiety and depression in patients with cancer, screening is important to increase its recognition, which will, in turn, help to direct referrals and deliver appropriate intervention. This study also generates greater insight into the association between psychosomatic complaints and psychological distress. Trial registration number MEC 896.52

Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship

Background. A good doctor–patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor–patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc. Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1–5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor–patient relationship. PPOS yields a mean score range of 1–6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression. Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05). Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care

Measuring patient views of physician communication skills: development and testing of the communication assessment tool. Patient Educ Couns

Abstract Objective: Interpersonal and communication skills have been identified as a core competency that must be demonstrated by physicians. We developed and tested a tool that can be used by patients to assess the interpersonal and communication skills of physicians-in-training and physicians-in-practice. Methods: We began by engaging in a systematic scale development process to obtain a psychometrically sound Communication Assessment Tool (CAT). This process yielded a 15-item instrument that is written at the fourth grade reading level and employs a five-point response scale, with 5 = excellent. Fourteen items focus on the physician and one targets the staff. Pilot testing established that the CAT differentiates between physicians who rated high or low on a separate satisfaction scale. We conducted a field test with physicians and patients from a variety of specialties and regions within the US to assess the feasibility of using the CAT in everyday practice. Results: Thirty-eight physicians and 950 patients (25 patients per physician) participated in the field test. The average patient-reported mean score per physician was 4.68 across all CAT items (S.D. = 0.54, range 3.97-4.95). The average proportion of excellent scores was 76.3% (S.D. = 11.1, range 45.7-95.1%). Overall scale reliability was high (Cronbach's alpha = 0.96); alpha coefficients were uniformly high when reliability was examined per doctor. Conclusion: The CAT is a reliable and valid instrument for measuring patient perceptions of physician performance in the area of interpersonal and communication skills. The field test demonstrated that the CAT can be successfully completed by both physicians and patients across clinical specialties. Reporting the proportion of ''excellent'' ratings given by patients is more useful than summarizing scores via means, which are highly skewed. Practice implications: Specialty boards, residency programs, medical schools, and practice plans may find the CAT valuable for both collecting information and providing feedback about interpersonal and communication skills.

Information and its impact on satisfaction among surgical patients

This study investigates the association between patient characteristics, reported problems with obtaining information and global evaluations of care among surgical patients. Using data from a large scale study of hospital care, a factor analysis of 30 information-relevant items was conducted with data from a sample of 3602 surgical patients; and correlation and multiple regression analyses were conducted to identify the relationships among information, patient characteristics and global evaluations of care. Path analysis was also used to determine the extent to which perceived control mediates the information-evaluation relationship. Four information factors were identified: surgical information, recovery information, general information and sensory information, and each was significantly related to global evaluations. Desire for involvement interacted with information received in determining patients' evaluations; and partial support was found for perceived control as a mediator of the information-evaluation link. The data indicate that the relationship between information and evaluations of quality is generalizable across patients, conditions and hospitals; and should be defined more broadly to include that which is given by a variety of providers, to family, and about medications and home recovery. Desire for involvement and perceived control must also be considered in understanding the value and impact of information.Hospitalization Surgical patients Patient satisfaction Patient information

Cross-cultural adaptation of the 4-Habits Coding Scheme into French to assess physician communication skills

International audienceBACKGROUND:The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians' communication skills from an external rater's perspective, based on video-recorded consultations.OBJECTIVE:To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties.METHODS:The 4-HCS was cross-culturally adapted by conducting forward and backward translations with independent translators, following international guidelines. Four raters rated 200 video-recorded medical student consultations with standardized patients, using the French version of the 4-HCS. We examined the internal consistency, factor structure, construct validity, and reliability of the 4-HCS.RESULTS:The mean overall 4-HCS score was 76.44 (standard deviation, 12.34), with no floor or ceiling effects across subscales. The median rating duration of rating was 8 min (range, 4-19). Cronbach's alpha was 0.94 for the overall 4-HCS, ranging from 0.72 to 0.88 across subscales. In confirmatory factor analysis, goodness-of-fit statistics did not corroborate the hypothesized 4-habit structure. Exploratory factor analysis resulted in two dimensions, with the merging of three conceptually related habits into a single dimension and substantial cross-loading for 15 out of 23 items. Median average absolute-agreement intra-class correlation coefficient estimates were 0.74 (range, 0.68-0.84) and 0.85 (range, 0.76-0.91) for inter- and intra-rater reliability of habit subscales, respectively.CONCLUSION:The French version of the 4-HCS demonstrates satisfactory internal consistency but requires the use of two independent raters to achieve acceptable reliability. The underlying factor structure of the original US version and cross-cultural adaptations of the 4-HCS deserve further investigation

Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools

PURPOSE: Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. The authors sought to identify key personal and cultural factors associated with intentions to leave one\u27s institution and/or academic medicine. METHOD: From 2007 through early 2009, the authors surveyed a stratified random sample of 4,578 full-time faculty from 26 representative U.S. medical schools. The survey asked about advancement, engagement, relationships, diversity and equity, leadership, institutional values and practices, and work-life integration. A two-level, multinomial logit model was used to predict leaving intentions. RESULTS: A total of 2,381 faculty responded (52%); 1,994 provided complete data for analysis. Of these, 1,062 (53%) were female and 475 (24%) were underrepresented minorities in medicine. Faculty valued their work, but 273 (14%) had seriously considered leaving their own institution during the prior year and 421 (21%) had considered leaving academic medicine altogether because of dissatisfaction; an additional 109 (5%) cited personal/family issues and 49 (2%) retirement as reasons to leave. Negative perceptions of the culture-unrelatedness, feeling moral distress at work, and lack of engagement-were associated with leaving for dissatisfaction. Other significant predictors were perceptions of values incongruence, low institutional support, and low self-efficacy. Institutional characteristics and personal variables (e.g., gender) were not predictive. CONCLUSIONS: Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere