Development and use of an instrument adapted to assess the clinical skills learning environment in the pre-clinical years.
BACKGROUND
The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools.


METHODS
The ten-item Pre-Clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach's alphas were calculated for emerging dimensions.


RESULTS
The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: "Patients as Objects", "Talking Respectfully of Colleagues", and "Patient-Centered Behaviors". Reliability measures (Cronbach's alpha) for the Pre-Clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions.


CONCLUSIONS
The Pre-Clinical C3 instrument's performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-Clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions.
Research Associate, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Rebecca E
RE
Rdesinski
Graduate student in Clinical Psychology, Pacifica Graduate Institute, Carpinteria, California (retired, June 2013, as Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon).
Kathryn G
KG
Chappelle
Professor, Division of Health Promotion and Sports Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon.
Diane L
DL
Elliot
D. Craig Brater Chair of Global Health Education, Professor of Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Debra K
DK
Litzelman
Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Ryan
R
Palmer
Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Frances E
FE
Biagioli
Evaluation; Patient-Centered Care; Preclinical curriculum; Professionalism