Table 1.
Chi square comparisons of preclinical (year 1/2) and clinical (year 3/4) students’ responses to each item on the Communication, Curriculum and Culture instrument
| Category | Domain | Item summary | Percent respondents answering in desired patient-centred fashion | p -value | |
|---|---|---|---|---|---|
| Year 1/2 in % | Year 3/4 in % | ||||
| Role modelling | Course faculty | Communicate concern and interest in patients as unique persons | 49 | 43 | 0.429 |
| Encourage patients’ participation in their own care | 39 | 33 | 0.431 | ||
| Take seriously patients’ concerns about their conditions or care | 56 | 49 | 0.418 | ||
| Develop good rapport with patients | 58 | 44 | 0.077 | ||
| * Explore emotional aspects of patients’ illnesses | 34 | 16 | 0.013 | ||
| Clinical mentors | * Communicate concern and interest in patients as unique persons | 57 | 37 | 0.011 | |
| Encourage patients’ participation in their own care | 44 | 33 | 0.149 | ||
| Take seriously patients’ concerns about their conditions or care | 53 | 44 | 0.264 | ||
| * Develop good rapport with patients | 65 | 48 | 0.034 | ||
| * Explore emotional aspects of patients’ illnesses | 39 | 22 | 0.018 | ||
| Students’ experiences | Patients as objects | * Preceptor overheard referring to patient as a diagnosis | 5 | 46 | <0.001 |
| * Little attention paid to social history | 12 | 37 | <0.001 | ||
| Patient waits longer than necessary | 3 | 11 | 0.056 | ||
| * Students overheard portraying patients as diagnoses rather than unique human beings | 16 | 39 | 0.001 | ||
| * Patient’s case discussed in front of patient as if the patient weren’t there | 4 | 24 | <0.001 | ||
| Learning relationships | Students’ stories portray how a patient encounter affected the student(s) personally | 58 | 59 | 0.894 | |
| * Student provided with feedback on bedside manner | 39 | 86 | <0.001 | ||
| * Student provided with feedback on listening skills | 29 | 67 | <0.001 | ||
| Advice given to students emphasizes the importance of good communication skills with patients | 70 | 75 | 0.525 | ||
| Bad news | Student asked to deliver bad news without any teaching or discussion about a caring approach | 94 | 96 | 0.445 | |
| Student asked to answer patient’s questions about bad news without any teaching | 92 | 91 | 0.809 | ||
| Support | – | * Student felt encouraged when an effort was made to develop rapport with patients | 88 | 73 | 0.018 |
| * Student felt encouraged when an effort was made to know patients as unique persons | 83 | 66 | 0.013 | ||
| * Student felt encouraged when an effort was made to legitimize patients’ concerns | 88 | 67 | 0.001 | ||