Abstract:
CONTEXT:Small declines in patient-centred attitudes during medical education have caused great concern. Although some of the self-report scales applied have solid psychometric foundations, validity evidence for the interpretation of attitude erosion during clerkships remains weak. OBJECTIVES:We sought to address this gap in a qualitative study of the relationships between scores on four commonly used attitude scales and participants' experiences and reflections. Our aim was to gain a better understanding of the score changes from the participants' perspectives. METHODS:We conducted semi-structured interviews with 15 junior doctors from a cohort (n = 37) that had previously shown a small decline in patient-centred attitudes during clerkships, measured on four self-report scales. In the interviews, we explored interviewees' experiences of their development of patient-centredness and subsequently discussed their scale scores, particularly for those items that contributed to a rise or decline in scores. We analysed the data using a process of constant comparison among personal experiences, scale scores and participants' explanations of score changes, applying the coding techniques of grounded theory. RESULTS:The analysis revealed important response distortions that might be responsible for small declines in scores during clerkships separately from changes in attitudes. The drastic alterations to the participants' frame of reference, attributable to the transition to clinical practice, represented the most prominent cause of distortion. More nuanced, context-specific, patient-centred reasoning resulted in more neutral responses after clerkships, paradoxically causing a decline in scores. In addition to response distortions, the interviews revealed shortcomings in content validity such as an 'extreme' construct of patient-centredness. CONCLUSIONS:This study calls into question the validity of the interpretation of attitude erosion during clerkships. The findings suggest that small declines in scores on self-report attitude scales are related to a recalibration of trainees' understandings of patient-centredness as they grow more clinically experienced. The evolved construct of patient-centredness and the way attitudes are measured require special attention in the development of future instruments.
journal_name
Med Educjournal_title
Medical educationauthors
Bombeke K,Symons L,Mortelmans D,Debaene L,Schol S,Van Royen P,De Winter Bdoi
10.1111/medu.12102subject
Has Abstractpub_date
2013-05-01 00:00:00pages
476-84issue
5eissn
0308-0110issn
1365-2923journal_volume
47pub_type
杂志文章abstract:CONTEXT:'Transfer' is the application of a previously learned concept to solve a new problem in another context. Transfer is essential for basic science education because, to be valuable, basic science knowledge must be transferred to clinical problem solving. Therefore, better understanding of interventions that enhan...
journal_title:Medical education
pub_type: 杂志文章,评审
doi:10.1111/medu.13519
更新日期:2018-06-01 00:00:00
abstract::Student assessment in community settings presents problems for medical teachers, e.g., difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, communit...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.1998.00151.x
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVE:This instalment in the series on professional assessment provides an introduction to methods of setting standards. METHOD:A standard is a special score that serves as a boundary between those who perform well enough and those who do not. The practical steps in selecting it include: deciding on the type of st...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2003.01495.x
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:In the present state of flux affecting UK medical undergraduate education, there is a pressing need for evaluative methods which will identify relevant outcomes both expected and unanticipated. The student perspective is now legitimately accepted to form part of any evaluative exercise but qualitative method...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.1999.00288.x
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of 3 years' ethics teaching (30 hours mainly small group teaching in year 1, 14 hours mainly lecture-type teaching in years 2 and 3) on students' proposed behaviour on encountering ethical dilemmas. DESIGN:Cohort design. SETTING:University of Glasgow Medical School. SUBJECTS:A cohort...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2002.01176.x
更新日期:2002-05-01 00:00:00
abstract::Undergraduate medical education in Britain has been in a state of change since before the introduction of the National Health Service. Since then the changes in the General Medical Councils's recommendations concerning the medical curriculum (1947, 1957, 1967) have accompanied attention to curricular content, and the ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1976.tb01484.x
更新日期:1976-09-01 00:00:00
abstract::Eighty-two house-physicians filled in a questionnaire concerning the care of self-poisoning patients with special emphasis on training and attitudes. These recently qualified doctors dealt with large numbers of such patients and expressed dissatisfaction with their training in this respect. Hostile attitudes towards t...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1981.tb02500.x
更新日期:1981-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1979.tb00926.x
更新日期:1979-03-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:
更新日期:2001-10-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1988.tb00790.x
更新日期:1988-11-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章,评审
doi:10.1111/medu.13117
更新日期:2016-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1997.tb00038.x
更新日期:1997-01-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2000.00561.x
更新日期:2000-04-01 00:00:00
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journal_title:Medical education
pub_type: 历史文章,杂志文章,评审
doi:10.1111/medu.13349
更新日期:2017-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/medu.14079
更新日期:2020-08-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1046/j.1365-2923.2002.01152.x
更新日期:2002-03-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1990.tb02521.x
更新日期:1990-03-01 00:00:00
abstract::There is evidence that nurses fulfil the requirements of objective judgement better than doctors. Simulation of Initial Medical Problem-Solving (SIMP), a paper-and-pencil test for the assessment of medical problem-solving, consists of case histories, followed by an open-ended question. The scoring of open-ended questi...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1989.tb01564.x
更新日期:1989-07-01 00:00:00
abstract::Although the cueing effects inherent in conventional multiple choice questions (MCQs) present serious limitations, this format continues to dominate testing programmes. The present study was undertaken to estimate the effects of cueing when MCQs are used to test medical students, and to evaluate the reliability, valid...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1993.tb00284.x
更新日期:1993-07-01 00:00:00
abstract::A new computerized system for the allocation of pre-registration house-officer appointments to medical graduates at the Welsh National School of Medicine is described. The need to withdraw an earlier system, used through much of the 1970s, is explained, and the advantages possessed by the new system are discussed. ...
journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1982.tb01253.x
更新日期:1982-07-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1981.tb02640.x
更新日期:1981-07-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1987.tb00674.x
更新日期:1987-03-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1993.tb00228.x
更新日期:1993-01-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1996.tb00852.x
更新日期:1996-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1979.tb01530.x
更新日期:1979-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章,多中心研究
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更新日期:2005-05-01 00:00:00
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journal_title:Medical education
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-08-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1984.tb01277.x
更新日期:1984-09-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1986.tb01374.x
更新日期:1986-07-01 00:00:00
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journal_title:Medical education
pub_type: 杂志文章
doi:10.1111/j.1365-2923.1978.tb00352.x
更新日期:1978-07-01 00:00:00