Not the same everywhere. Patient-centered learning environments at nine medical schools.
BACKGROUND
Learning environments overtly or implicitly address patient-centered values and have been the focus of research for more than 40 years, often in studies about the "hidden curriculum." However, many of these studies occurred at single medical schools and used time-intensive ethnographic methods. This field of inquiry lacks survey methods and information about how learning environments differ across medical schools.


OBJECTIVE
To examine patient-centered characteristics of learning environments at 9 U.S. medical schools.


METHODS
Cross-sectional internet-based survey.


METHODS
Eight-hundred and twenty-three third- and fourth-year medical students in the classes of 2002 and 2003.


METHODS
We measured the patient-centeredness of learning environments with the Communication, Curriculum, and Culture (C3) Instrument, a 29-item validated measure that characterizes the degree to which a medical school's environment fosters patient-centered care. The C3 Instrument contains 3 content areas (role modeling, students' experiences, and support for students' patient-centered behaviors), and is designed to measure these areas independent of respondents' attitudes about patient-centered care. We also collected demographic and attitudinal information from respondents.


RESULTS
The variability of C3 scores across schools in each of the 3 content areas of the instrument was striking and statistically significant (P values ranged from .001 to .004). In addition, the patterns of scores on the 3 content areas differed from school to school.


CONCLUSIONS
The 9 schools demonstrated unique and different learning environments both in terms of magnitude and patterns of characteristics. Further multiinstitutional study of hidden curricula is needed to further establish the degree of variability that exists, and to assist educators in making informed choices about how to intervene at their own schools.
Haidet
Paul
P
The Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, USA. phaidet@bcm.tmc.edu
Kelly
P Adam
PA
Bentley
Susan
S
Blatt
Benjamin
B
Chou
Calvin L
CL
Fortin
Auguste H
AH
Gordon
Geoffrey
G
Gracey
Catherine
C
Harrell
Heather
H
Hatem
David S
DS
Helmer
Drew
D
Paterniti
Debora A
DA
Wagner
Dianne
D
Inui
Thomas S
TS
D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum; D003625:Data Collection; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D017145:Models, Educational; D018802:Patient-Centered Care; D012577:Schools, Medical / Q000458:organization & administration*; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods; D014481:United States