Assessing patient-centered care: one approach to health disparities education.
BACKGROUND
Patient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the preferences of each patient. In order to evaluate the effectiveness of a curriculum in teaching patient-centered care (PCC) behaviors to medical students, we drew on the work of Kleinman, Eisenberg, and Good to develop a scale that could be embedded across cases in an objective structured clinical examination (OSCE).


OBJECTIVE
To compare the reliability, validity, and feasibility of an embedded patient-centered care scale with the use of a single culturally challenging case in measuring students' use of PCC behaviors as part of a comprehensive OSCE.


METHODS
A total of 322 students from two California medical schools participated in the OSCE as beginning seniors. Cronbach's alpha was used to assess the internal consistency of each approach. Construct validity was addressed by establishing convergent and divergent validity using the cultural challenge case total score and OSCE component scores. Feasibility assessment considered cost and training needs for the standardized patients (SPs).


RESULTS
Medical students demonstrated a moderate level of patient-centered skill (mean = 63%, SD = 11%). The PCC Scale demonstrated an acceptable level of internal consistency (alpha = 0.68) over the single case scale (alpha = 0.60). Both convergent and divergent validities were established through low to moderate correlation coefficients.


CONCLUSIONS
The insertion of PCC items across multiple cases in a comprehensive OSCE can provide a reliable estimate of students' use of PCC behaviors without incurring extra costs associated with implementing a special cross-cultural OSCE. This approach is particularly feasible when an OSCE is already part of the standard assessment of clinical skills. Reliability may be increased with an additional investment in SP training.
Wilkerson
LuAnn
L
UCLA David Geffen School of Medicine, Center for Educational Development & Research, University of California, Los Angeles, Los Angeles, CA 90095-1722, USA.
Fung
Cha-Chi
CC
May
Win
W
Elliott
Donna
D
D003431:Cross-Cultural Comparison; D004501:Education, Medical / Q000379:methods / Q000592:standards*; D004521:Educational Measurement / Q000379:methods / Q000592:standards*; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D013337:Students, Medical