title: Impact of student ethnicity and patient-centredness on communication skills performance.
abstract: OBJECTIVE
  The development of patient-centred attitudes by health care providers is critical to improving health care quality. A prior study showed that medical students with more patient-centred attitudes scored higher in communication skills as judged by standardised patients (SPs) than students with less patient-centred attitudes. We designed this multicentre study to examine the relationships among students' demographic characteristics, patient-centredness and communication scores on an SP examination.
  
  
  METHODS
  Early Year 4 medical students at three US schools completed a 12-item survey during an SP examination. Survey items addressed demographics (gender, ethnicity, primary childhood language) and patient-centredness. Factor analysis on the patient-centredness items defined specific patient-centred attitudes. We used multiple regression analysis incorporating demographic characteristics, school and patient-centredness items and examined the effect of these variables on the outcome variable of communication score.
  
  
  RESULTS
  A total of 351 students took the SP examination and 329 (94%) completed the patient-centredness questionnaire. Responses indicated generally high patient-centredness. Student ethnicity and medical school were significantly associated with communication scores; gender and primary childhood language were not. Two attitudinal factors were identified: patient perspective and impersonal attitude. Multiple regression analysis revealed that school and scores on the impersonal factor were associated with communication scores. The effect size was modest.
  
  
  CONCLUSIONS
  In a medical student SP examination, modest differences in communication scores based on ethnicity were observed and can be partially explained by student attitudes regarding patient-centredness. Curricular interventions to enhance clinical experiences, teaching and feedback are needed to address key elements of a patient-centred approach to care.
authors.affiliation: Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA 94143-0120, USA. Karen.hauer@ucsf.edu
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.forename: Neil
authors.initials: N
authors.lastname: Gesundheit
authors.forename: Andrew
authors.initials: A
authors.lastname: Nevins
authors.forename: Malathi
authors.initials: M
authors.lastname: Srinivasan
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D004504:Education, Medical, Undergraduate; D005006:Ethnicity; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D018802:Patient-Centered Care / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires