title: Medical students' perceptions of the patient-centredness of the learning environment.
abstract: BACKGROUND
  Patient-centred care is an important aspect of quality health care. The learning environment may impact medical students' adoption of patient-centred behaviours.
  
  
  METHODS
  All medical students at a single institution received an anonymous, modified version of the Communication, Curriculum, and Culture instrument that measures patient-centredness in the training environment along three domains: role modelling, students' experience, and support for patient-centred behaviours. We compared domain scores and individual items by class year and gender, and qualitatively analyzed responses to two additional items that asked students to describe experiences that demonstrated varying degrees of patient-centredness.
  
  
  RESULTS
  Year 1 and 2 students reported greater patient-centredness than year 3 and 4 students in each domain: role modelling (p = 0.03), students' experience (p = <0.001), and support for patient-centred behaviours (p < 0.001). Female students reported less support for patient-centred behaviours compared with male students (p = 0.03). Qualitative analysis revealed that explicit patient-centred curricula and positive role modelling fostered patient-centredness. Themes relating to low degrees of patient-centredness included negative role modelling and students being discouraged from being patient-centred.
  
  
  CONCLUSIONS
  Students' perceptions of the patient-centredness of the learning environment decreased as students progressed through medical school, despite increasing exposure to patients. Qualitative analysis found that explicit patient-centred curricula cultivated patient-centred attitudes. Role modelling impacted student perceptions of patient-centredness within the learning environment.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Mark V
authors.initials: MV
authors.lastname: Wilcox
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Orlando
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Record
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Christmas
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Ziegelstein
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA. lhanyok2@jhmi.edu.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hanyok
keywords: Empathy; Learning environment; Medical student; Patient-centredness