title: Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.
abstract: BACKGROUND
  Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students' attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones.
  
  
  METHODS
  Students at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified.
  
  
  RESULTS
  Student confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care.
  
  
  CONCLUSIONS
  A new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.
authors.affiliation: The Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton, 3053, VIC, Australia. r.mcnair@unimelb.edu.au.
authors.forename: Ruth
authors.identifier: http://orcid.org/0000-0002-4738-8781
authors.initials: R
authors.lastname: McNair
authors.affiliation: Northern Clinical School, Melbourne Medical School, the University of Melbourne, 185 Cooper St, Epping, 3076, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Griffiths
authors.affiliation: Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia.
authors.forename: Katharine
authors.initials: K
authors.lastname: Reid
authors.affiliation: Melbourne Medical School, The University of Melbourne, Parkville, VIC, 3010, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Sloan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D018802:Patient-Centered Care / Q000592:standards*; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Clinical education; Community based education; Qualities/skills/values/attitudes