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Caring Attitudes in Medical Education: Perceptions of Deans and Curriculum Leaders

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Abstract

BACKGROUND

Systems of undergraduate medical education and patient care can create barriers to fostering caring attitudes.

OBJECTIVE

The aim of this study is to survey associate deans and curriculum leaders about teaching and assessment of caring attitudes in their medical schools.

PARTICIPANTS

The participants of this study include 134 leaders of medical education in the USA and Canada.

METHODS

We developed a survey with 26 quantitative questions and 1 open-ended question. In September to October 2005, the Association of American Medical Colleges distributed it electronically to curricular leaders. We used descriptive statistics to analyze quantitative data, and the constant comparison technique for qualitative analysis.

RESULTS

We received 73 responses from 134 medical schools. Most respondents believed that their schools strongly emphasized caring attitudes. At the same time, 35% thought caring attitudes were emphasized less than scientific knowledge. Frequently used methods to teach caring attitudes included small-group discussion and didactics in the preclinical years, role modeling and mentoring in the clinical years, and skills training with feedback throughout all years. Barriers to fostering caring attitudes included time and productivity pressures and lack of faculty development. Respondents with supportive learning environments were more likely to screen applicants’ caring attitudes, encourage collaborative learning, give humanism awards to faculty, and provide faculty development that emphasized teaching of caring attitudes.

CONCLUSIONS

The majority of educational leaders value caring attitudes, but overall, educational systems inconsistently foster them. Schools may facilitate caring learning environments by providing faculty development and support, by assessing students and applicants for caring attitudes, and by encouraging collaboration.

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Acknowledgment

Dr. Lown, Dr. Chou, Dr. Clark, Dr. Haidet, Dr. White, Dr. Krupat, and Dr. Weissmann of the American Academy on Communication in Healthcare received honoraria from the Arthur Vining Davis Foundations for their participation in this work. Dr. White is employed by Healthcare Quality and Communication Improvement, LLC. The authors report no conflict of interest. We wish to acknowledge the Arthur Vining Davis Foundations for their vision and support. The opinions contained herein are those of the authors and do not necessarily represent the views of the Arthur Vining Davis Foundations, the American Academy on Communication in Healthcare, the Association of American Medical Colleges, the US Department of Veterans Affairs, or the home institutions of the authors.

Funding for this study was provided by the Arthur Vining Davis Foundations.

Author information

Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    Beth A. Lown MD, William D. Clark MD, Edward Krupat PhD & Stephen Pelletier PhD

  2. Department of Medicine, Mount Auburn Hospital, 300 Mount Auburn Street, Cambridge, MA, 02138, USA

    Beth A. Lown MD

  3. American Academy on Communication in Healthcare, Chesterfield, MO, USA

    Beth A. Lown MD, Calvin L. Chou MD, PhD, William D. Clark MD, Paul Haidet MD, MPH, Maysel Kemp White PhD, Edward Krupat PhD & Peter Weissmann MD

  4. University of California, San Francisco, CA, USA

    Calvin L. Chou MD, PhD

  5. Veterans Administration Medical Center, San Francisco, CA, USA

    Calvin L. Chou MD, PhD

  6. Baylor College of Medicine, Houston, TX, USA

    Paul Haidet MD, MPH

  7. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Paul Haidet MD, MPH

  8. Healthcare Quality and Communication Improvement, LLC, Chester, CT, USA

    Maysel Kemp White PhD

  9. University of Minnesota Medical School, Minneapolis, MN, USA

    Peter Weissmann MD

  10. Hennepin County Medical Center, Minneapolis, MN, USA

    Peter Weissmann MD

  11. The Association of American Medical Colleges, Washington, DC, USA

    M. Brownell Anderson MEd.

Authors
  1. Beth A. Lown MD
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  2. Calvin L. Chou MD, PhD
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  3. William D. Clark MD
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  4. Paul Haidet MD, MPH
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  5. Maysel Kemp White PhD
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  6. Edward Krupat PhD
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  7. Stephen Pelletier PhD
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  8. Peter Weissmann MD
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  9. M. Brownell Anderson MEd.
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Corresponding author

Correspondence to Beth A. Lown MD.

Appendices

APPENDIX A

Caring attitudes survey instrument

  1. 1.

    Please indicate your title within your institution.

    1. a.

      Dean

    2. b.

      Associate Dean of Medical Education and/or Curricular Affairs

    3. c.

      Other

  2. 2.

    Please indicate if your medical school is a public or private institution.

  3. 3.

    Please check the region of the country in which your school is located.

    1. a.

      Northeast

    2. b.

      Midwest

    3. c.

      South

    4. d.

      West

  4. 4.

    Please indicate the approximate size of the class of 2009.

    1. a.

      <100

    2. b.

      101–150

    3. c.

      >150

Response options for questions 5–11: strongly agree, agree, disagree, strongly disagree

  1. 5.

    If students do not come to school with caring attitudes, it is difficult to teach these.

  2. 6.

    Caring attitudes are emphasized strongly during the preclerkship years at this school.

  3. 7.

    Caring attitudes are emphasized strongly during the clerkship years at this school.

  4. 8.

    Caring attitudes are emphasized at least as much as learning scientific knowledge at this school.

  5. 9.

    Students are strongly encouraged to engage in collaborative learning at this school.

  6. 10.

    The vast majority of students at this school consistently demonstrate caring attitudes by the time they graduate.

  7. 11.

    Faculty development programs at this school strongly emphasize the recognition and teaching of caring attitudes.

Response options for questions 12–19: yes, no, don’t know

  1. 12.

    Does your school ask interviewers to assess caring attitudes in medical school applicants?

  2. 13.

    If yes, does your school formally train interviewers how to assess these attitudes?

  3. 14.

    Does your school have a program or resource (such as a dean, formal wellness program, or ombudsperson) that encourages and assists students who wish to examine conflicts between their professional and personal responsibilities?

  4. 15.

    Does your school require students to participate in a course during which they learn collaboratively with other health science students (e.g., nurses, social workers, and others)?

  5. 16.

    Does your school give annual awards to the faculty based on caring and humanism?

  6. 17.

    Does your school require community service of all students as part of their medical school experience?

  7. 18.

    Does your school have guidelines to ensure that women and underrepresented minorities receive salaries equivalent to others with similar qualifications, academic rank and hours?

  8. 19.

    Has your school defined competency requirements for the demonstration of caring attitudes?

  9. 20.

    Many methods can be used to teach and foster caring attitudes. Please check the 3 predominant methods your school uses to teach caring attitudes during the preclerkship years, and 3 during the clerkship years.

    1. a.

      Didactic sessions

    2. b.

      Problem or case-based learning (PBL)

    3. c.

      Small group discussions (other than PBL, e.g., personal awareness or mindfulness)

    4. d.

      Team learning

    5. e.

      Role modeling

    6. f.

      Mentoring

    7. g.

      Skills training, or feedback on directly observed skills

    8. h.

      Electronic (web or CD-ROM) based teaching

    9. i.

      Other

Response options for questions 21–22: virtually all, most, some, very few

  1. 21.

    How many students have an ongoing formal mentoring relationship with a faculty member at your school?

  2. 22.

    For each of the following groups at your school, how many consistently model caring attitudes toward students?

    1. a.

      Pre-clerkship faculty

    2. b.

      Clerkship faculty

    3. c.

      Research faculty

    4. d.

      House staff

  3. 23.

    Of the following potential barriers to teaching or enhancing students’ caring attitudes, please check the 3 that are most significant at your school:

    1. a.

      Paucity of faculty role models

    2. b.

      Lack of designated time in the curriculum

    3. c.

      Time pressures on faculty, increasing demands for productivity

    4. d.

      Lack of faculty development and expertise in teaching in this domain

    5. e.

      Faculty don’t perceive this as important

    6. f.

      Students don’t perceive this as important

    7. g.

      Faculty believe current teaching of this is adequate

    8. h.

      The general learning climate on clerkship rotations is hostile to caring attitudes

    9. i.

      The leadership of the medical school does not feel this is a high priority

  4. 24.

    Of the following methods of assessing students’ caring attitudes, please check the 3 predominant methods used at your school.

    1. a.

      Students’ case presentations

    2. b.

      Direct faculty observations of students’ interactions with each other

    3. c.

      Direct faculty observation of students’ interactions with patients and families

    4. d.

      Students’ peer review of observations of each other

    5. e.

      Reports from house staff.

    6. f.

      Direct faculty observation of students’ interactions with the healthcare team (nurses, ward staff, others)

    7. g.

      Patients’ and families’ comments

    8. h.

      Standardized patient assessment exercises or objective structured clinical examinations (OSCE)

    9. i.

      Observations or comments by nurses and other allied health professionals

    10. j.

      Other

  5. 25.

    In your school’s clinical skills examinations, what percent of the students’ grade is dependent on interpersonal and communication skills?

    1. a.

      0

    2. b.

      1–20%

    3. c.

      21–40%

    4. d.

      >40%

    5. e.

      We don’t have a clinical skills examination

    6. f.

      Do not know

  6. 26.

    For the items below, please check each domain in which your medical school has provided formal faculty development programs within the past year.

    1. a.

      General teaching skills

    2. b.

      Communication skills

    3. c.

      Cultural sensitivity and communication

    4. d.

      Giving and receiving feedback

    5. e.

      Facilitating caring attitudes in students

    6. f.

      Teaching professionalism

    7. g.

      Group facilitation skills

    8. h.

      Mentoring skills

    9. i.

      Facilitating self-reflection and personal awareness

    10. j.

      Physician wellness

Question 27 allowed a free text response

  1. 27.

    Critics of medical education assert that students often fail to master the interpersonal and communication skills that allow them to display caring attitudes, and that a “hidden curriculum” in medical training hampers further development of, or actually diminishes caring attitudes. Please comment on the active steps your school now takes to ensure that students master advanced relationship-building skills, and steps taken to address the negative effects of the “hidden curriculum” at your school.

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Lown, B.A., Chou, C.L., Clark, W.D. et al. Caring Attitudes in Medical Education: Perceptions of Deans and Curriculum Leaders. J GEN INTERN MED 22, 1514–1522 (2007). https://doi.org/10.1007/s11606-007-0318-x

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  • DOI: https://doi.org/10.1007/s11606-007-0318-x

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