FIRST YEAR MEDICAL STUDENTS’ PATIENT-CENTERED BELIEF:

EFFECT OF SOCIAL MEDIA

H. Omer Tontus

Ondokuz Mayis University, Medical Faculty, Medical Education Department, Samsun, Turkey

  • Objective: Our goal was to identify students’ characteristics changes associated with patient-centered beliefs about the sharing of information and caring power, in their early first year by “a social media practice”.
  • Study Design: Students provided demographic information and completed a scale assessing their beliefs about sharing and caring information with patients before and after a social media video presentation. 18 items questionnaire used to determine their belief about thinking alike patients.
  • Population: Year 1 students from a large medical faculty were included. One hundred forty-six students participatedto activity.
  • Outcomes Measured: We measured year 1 students’ attitudes changes before and after activity by using an 18 items pre-defined questionnaire.
  • Results: Among students, patient-centered beliefs were associated with being female in mean score. When comparing before and after activity score, four items’ response changes were found statistically important.
  • Conclusions: The extent of congruence between medical professionals’ and their patient-centered beliefs plays an essential role in health-care service. Students’ perceptions as near future’s professionals are important and have to check by curriculum designer through their graduation.

Key words: Physician-patient relations; patient-centered care; social media; PPOS; sharing; caring

INTRODUCTION:

A patient-centered approach to care has been widely accepted (1, 2).One of the most important factors which directly related with patient-centeredness is curriculum designing in undergraduate medical education.Students who take a patient-centered approach education are more likely to treat them as partners (3). This approach has been associated with improved health-care outcomes (4).Good communication skill produces a therapeutic effect for the patient, as has beenvalidated in some controlled studies. Recognized formal training programshave been created to enhance and measure specificcommunicationskills. Many of these efforts, however, focus onmedical schools and early postgraduate years and, therefore,remain isolated in academic settings (5). One of the purpose of this study is to offer curriculum designers a practical techniques for improved communication withpatients by using social media.

Some patientsmay desire a physician whose style is wellplanned and who provides more guidance (6, 7) Patients who have serious health problems expect their physicians to provide more direction (8, 9). Medical professionals should have value of patient-centeredness (3).

Our study involves the measurement of patient-centeredness among the year 1 students in their very early period in medical school, in the sharing and caring domains. Pre-medical school personal characteristics of students were associated with patient-centered beliefs by their cultural or educational background. We investigated the effect of educational activities.

Methods

Student attitudes toward the doctor–patient relationship were measured using a previously validated18 items “Patient–Practitioner OrientationScale (PPOS)” instrument by Krupat et al (10).There aretwo subscales each consist of 9 items and termed as ‘sharing’ and ‘caring’ subscales (10-12). The sharingsubscale measure the degreeto which the respondent believes that power andcontrol should be shared between doctor and patient,and the degree to which doctors should share informationwith the patient. Thecaring subscales measurethe extent to which the respondent cares about thevalue of affection andinquire about psychosocial issues and humanistic approach of medicine. Form designed as fill-out format with 6-point Likert scale from strongly agree to strongly disagree. A higher score indicates an orientation that is more patient-centered.The PPOS, which has been shown to have good reliability and validity, measures the beliefs of both sides along a dimension that ranges from patient-centered to physician-centered (3).

The data we report collected during their very first week in medical education from Year 1 students of theMedical Faculty of Ondokuz Mayis University. Students in the study were surveyed before and immediately after lecture which includes a YouTube video tagged as “TEDxMaastricht - Bas Bloem - "From God to Guide"” by Prof. Bas Bloem.

All students in the study were surveyed at the beginning of the opening lecture assigned by medical education department. During the lecture the video presented and following the video students re-surveyed by the same questionnaire. Video was 11 min 11 sec. and with 11774 total viewing counts found by the time of the lecture (). Video was recorded in English.

185 new students accepted to the medical faculty in 2011-2012 educational year for their 6 years duration undergraduate medical education. Students’ attitudes towards the doctor–patient relationship were measured using the Patient–Practitioner Orientation Scale (PPOS). 153 students joined the lecture and 146 (95.42%) of them filled out the printed PPOSquestionnaire before and after the video presentation, which also enclosed demographic questions. Turkish subtitle added to video for the students who are not familiar with English language.

We identified that students who good at understanding English and/or good to read Turkish subtitle completed the questionnaires without need of assistance. Students who are native language other than English or Turkish needed for some kind of help to respond questionnaire. 7 students participated to the lecture but declined to fill forms. Students filled out the printed PPOS forms at the beginning and end of the lecture. The evaluative instrumentswere scored so that a higher score indicated a more positive evaluation. Itemswhich numbered as 9, 11 and 17 are scored reversely.

We first analyzed the data separately for pre-videoand post-video session scores using means (Table 1). Following this we tried to find statistical importance by Wilcoxontwo-related-sample test to determine the differences between pre and post activity scores on patient-centered beliefs of students. Analyses were conducted to determine the difference of (1) the pre-lecturePPOS, (2) the post-lecture PPOS, and (3) the difference between gender dependent PPOS evaluations. For statistical analyses we used SPSS 16.0 and Wilcoxon Signed Ranks Test used t for determining of statistical importance.

Results

146 (95.42%) students of 153 participated to study and 85 (58.2%) of them were female students. Youngest students were 17 and oldest students were 23 years of age with 18.47 years mean age. Pre and post activity students’ attitudes toward sharing power and caring information were measured using the PPOS. Table.1 shows means scores with SD of each item. We were able to compare the scores of questionnaires. Although the highest pre-video presentation score was for item 9 with 4.75 over 6, none of the scores were found over 5. Two of the post-video items scored by higher than 5 which are item 9 and item 17. Students’ post-activity mean scores were higher than pre-activity mean score (p>0.05). Some certain items’ score changes were statistically important (item 1, 9, 11, 16 and 17). Two of them, item 1 and 9 were from sharing subscale and remaining three items from caring subscale.

Pre-video / Post-video
item no / ITEMS / Mean / SD / Mean / SD / P value
1 / The doctor is the one who should decide what gets talked about during a visit / 2,89 / 1,22 / 3,51 / 1,17 / 0,000
2 / If health care is less personal these days, this is a small price to pay for medical advances / 3,82 / 1,26 / 4,03 / 1,24 / 0,153
3 / The most important part of the standard medical visit is the physical exam / 3,18 / 1,04 / 3,34 / 1,15 / 0,148
4 / It is often best for patients if they do not have a full explanation of their medical condition / 2,82 / 1,40 / 2,70 / 1,28 / 0,422
5 / Patients should rely on their doctors’ knowledge and not try to find out their conditions on their own / 2,81 / 1,57 / 3,07 / 1,51 / 0,173
6 / When doctors ask a lot of questions about a patient’s background, they are prying too much into personal matters / 3,18 / 0,81 / 3,26 / 1,15 / 0,438
7 / If doctors are truly good at diagnosis and treatment, the way they relate to patients is not that important / 4,32 / 1,26 / 4,32 / 1,41 / 0,816
8 / Many patients continue asking questions even though they are not learning anything new / 3,27 / 1,01 / 2,99 / 1,24 / 0,063
9 / Patients should be treated as if they were partners with the doctor, equal in power and status / 4,75 / 1,38 / 5,24 / 1,05 / 0,001
10 / Patients generally want reassurance rather than information about their health / 2,36 / 1,16 / 2,44 / 1,23 / 0,289
11 / If a doctor mainly relies on being open and warm, the doctor will not have a lot of success / 4,21 / 1,47 / 4,88 / 1,36 / 0,000
12 / When patients disagree with their doctor, this is a sign that the doctor does not have the patient’s respect and trust / 3,59 / 1,27 / 3,70 / 1,29 / 0,561
13 / A treatment plan cannot succeed if it is in conflict with a patient’s lifestyle or values / 4,01 / 1,28 / 4,09 / 1,13 / 0,511
14 / Most patients want to get in and out of the doctor’s office as quickly as possible / 2,26 / 1,37 / 2,32 / 1,27 / 0,509
15 / The patient must always be aware that the doctor is in charge / 2,11 / 1,37 / 2,34 / 1,36 / 0,110
16 / It is not that important to know a patient’s culture and background in order to treat the person’s illness / 3,59 / 1,36 / 4,32 / 1,29 / 0,000
17 / A friendly manner is a major ingredient in the doctor’s treatment of the patient / 4,53 / 1,29 / 5,22 / 0,95 / 0,000
18 / When patients find out medical information on their own, this usually confuses more than it helps / 2,79 / 0,97 / 2,94 / 1,25 / 0,300
Total Score / 60,48 / 64,70
Meean PPOS Score / 3,36 / 3,59 / 0,000

Table 1. Item by item mean PPOS scores pre and post video activity.

As shown in Table.2male & female students’ post-video scores significantly different than pre-video score in overall PPOS, sharing subscale and caring subscale (p<0.05 for all). In male students’ changes on sharing subscale founds as statistically un-important (p>0.05). Although female students were more patient-centered in their beliefs, male and female score differences within the subscale was statistically non-significant. The scores of male and female were very similar especially in caring subscale (3.98 and 3.97, respectively).

Overall PPOS / Sharing Subscale* / Caring Subscale**
Pre-video / Post-video / p value / Pre-video / Post-video / p value / Pre-video / Post-video / p value
PPOS scores / 3,36 / 3,59 / 0,000 / 3,04 / 3,21 / 0.004 / 3,68 / 3,97 / 0.000
Male / 3,38 / 3,58 / 0,002 / 3,08 / 3,17 / 0.222 / 3,69 / 3,98 / 0.000
Female / 3,34 / 3,61 / 0,000 / 3,01 / 3,24 / 0.009 / 3,67 / 3,97 / 0.000
*Sharing Score (items 1, 4, 5, 8, 9, 10, 12, 15, 18)
**Caring Score (items 2, 3, 6, 7, 11, 13, 14, 16, 17)

Table 2.Mean PPOS, Sharing and Caring scores pre and post video activity.

Students’ beliefs were measured in 2 different ways: pre-video and post-video. For each measure, the analysis was run 3 times, each using a different predictor. First, we entered the pre-video’ PPOS scores as the only predictor, then the post-video PPOS scores, and then the difference between the students’ sharing and caring subscale scores (Table.2).In another table (Table.3) we tried to find attitudes change per item main PPOS score depending on gender. While male students showed statistical significant difference in four items (item 1, 11, 16 and 17), female students showed another significantly changed item (item 9).

Male / Female
Items / Pre-video / Post Video / Asymp. Sig. (2-tailed) * / Pre-video / Post Video / Asymp. Sig. (2-tailed) *
1 / 3,03 / 3,67 / 0,001 / 2,79 / 3,40 / 0,001
2 / 4,07 / 4,23 / 0,349 / 3,65 / 3,88 / 0,268
3 / 3,25 / 3,44 / 0,348 / 3,13 / 3,27 / 0,261
4 / 2,77 / 2,79 / 0,889 / 2,85 / 2,64 / 0,244
5 / 2,59 / 2,85 / 0,337 / 2,96 / 3,22 / 0,355
6 / 3,13 / 3,15 / 0,731 / 3,22 / 3,34 / 0,466
7 / 4,15 / 4,16 / 0,889 / 4,45 / 4,45 / 0,828
8 / 3,26 / 2,92 / 0,173 / 3,28 / 3,05 / 0,209
9 / 4,90 / 5,07 / 0,367 / 4,64 / 5,36 / 0,001
10 / 2,46 / 2,54 / 0,681 / 2,28 / 2,36 / 0,299
11 / 4,16 / 4,79 / 0,005 / 4,24 / 4,94 / 0,001
12 / 3,59 / 3,49 / 0,584 / 3,59 / 3,85 / 0,238
13 / 4,05 / 4,07 / 0,925 / 3,99 / 4,11 / 0,522
14 / 2,39 / 2,43 / 0,728 / 2,16 / 2,25 / 0,539
15 / 2,33 / 2,51 / 0,553 / 1,95 / 2,21 / 0,107
16 / 3,36 / 4,36 / 0,000 / 3,75 / 4,28 / 0,016
17 / 4,46 / 5,15 / 0,000 / 4,58 / 5,27 / 0,000
18 / 2,92 / 2,80 / 0,409 / 2,69 / 3,04 / 0,062
*by Wilcoxon Signed Ranks Test

Table 3.Mean PPOS per item with gender discriminator showing scores pre and post video activity.

Three individual items in male group mean PPOS score dropped after social-media presentation which are item 8, 12 and 18. In female group score fall found in items 4 and 8. All these items are grouped in sharing subscale.

Discussion

The results of our study provide us with information about where patient-centered beliefs reside. This study demonstrates that medical students’ orientation at the end of YouTube video presentation of Prof. Bas Bloem’ “From God to Guide” is affected participant student to more patient-centered regarding the sharing dimension and caring part of their relationship with patients. We found that students are apparently (statistically significant) affected by the activity about all scale except male students’ sharing subscale.

Social media has the power to renovate academic design and engage teachers and learners in new ways. Using social media in medical education can not only engage 21st century students, but also teach the next generation of medical professionals the best practices for using these tools.

Social media is a term which describes the freely available web tools and applications designed to make possible online communication and interaction with information sharing such as slide sets, videos, and audios. Sharply increasing popularity of social media tools has been primarily driven by leisure, hobby and personal use. Medical educators are now beginning to recognize that social media has the potential to transform learning environments. When considering use of social media, the educatorshould focus on teaching and learning objectives, select a tool or application which supports those objectives, and determinea method to assess efficacy (13). We tried to determine effect of social media in medical education as Saarinen at al mentioned in their publication. We found that these kind of educational activities directly affect students pre and post activity attitudes or knowledge.

Data on comparing the patient-centeredness of different level of medical professional andmedical students is sparse. Patient-centeredness is accepted as one of the most important keyelement of quality in the health care system. There is some evidence that hospital-based exposure in the clinical clerkship period can result shift through good doctor–patient relationships and communication (10, 14-15). In our study we found “patient-centered belief education”can start as early as in first term in medical school.

We tried to find effect of YouTube video education in undergraduate medical educations on patient-centered care. We found that education is resulting with flourished patient-centeredness. Similar findings have been reported by Haidet et al (16).

In their 2007 study, Tsimtsiou et al noticed that attitudes were significantly more doctor-centered at the end of students’ education compared to the beginning of their clinical curricula (17). Also they noted that, this should be attributed mainly to the absence of mandatory courses addressing doctor–patient communication in the curriculum. The results of our study also indicate that curricular design needs for the introduction of communication themed lectures or other kind of educational activities such as use of social media. We believe that education for patient-centeredness should have to start in early years.

Researcher noticed that gender becomes less influential in students’ attitudes towards patient-centeredness (17). In our study group although there was some difference in the mean score of the PPOS, sharing or caring subscale scores we didn’t find any statistical difference between male and female students groups’ mean scores.

Our result supports, study of Hock Lee et al that they noticed further studies on the relationship between culture and patient-centered attitudes will contribute to curriculum development (18). It had been suggested that patient-centered care is universally desired by all patients.

Conclusions:

Encouraging patient-centered attitudes of medical students by curricular models, our datasuggest that they should be educated for their attitudes become more patient centered. Given theemphasis placed on patient satisfaction based care in the current medical environment, our studyresults indicate that at the admission, students already have background believes about patient-physician interaction. In the way of being a medical professional, early years of medical education is very important for the humanitarian aspect of medicine. There is a Turkish proverb is matching with the situation “You can only give shape to young trees”.

This manuscript is free from any competing interest.

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