Medical education
Medical student socio-demographic characteristics and attitudes toward patient centered care: Do race, socioeconomic status and gender matter? A report from the Medical Student CHANGES study

https://doi.org/10.1016/j.pec.2014.11.013Get rights and content

Abstract

Objective

To determine whether attitudes toward patient-centered care differed by socio-demographic characteristics (race, gender, socioeconomic status) among a cohort of 3191 first year Black and White medical students attending a stratified random sample of US medical schools.

Methods

This study used baseline data from Medical Student CHANGES, a large national longitudinal cohort study of medical students. Multiple logistic regression was used to assess the association of race, gender and SES with attitudes toward patient-centered care.

Results

Female gender and low SES were significant predictors of positive attitudes toward patient-centered care. Age was also a significant predictor of positive attitudes toward patient-centered care such that students older than the average age of US medical students had more positive attitudes. Black versus white race was not associated with attitudes toward patient-centered care.

Conclusions

New medical students’ attitudes toward patient-centered care may shape their response to curricula and the quality and style of care that they provide as physicians. Some students may be predisposed to attitudes that lead to both greater receptivity to curricula and the provision of higher-quality, more patient-centered care.

Practice implications

Medical school curricula with targeted messages about the benefits and value of patient-centered care, framed in ways that are consistent with the beliefs and world-view of medical students and the recruitment of a socioeconomically diverse sample of students into medical schools are vital for improved care.

Introduction

The physician–patient relationship is central to the delivery of high-quality care [1]. Lower interpersonal quality of care has been shown to impact patient satisfaction; biological, psychological and social outcomes; [2], [3], [4], [5], [6] the delivery of preventive care services [7], [8], [9], and patient adherence to treatment [9], [10], [11], [12]. Poor quality physician–patient relationships may also contribute to health disparities [13], [14], [15], [16] whereas care that focuses on building a personal relationship, communication, trust and empathy while emphasizing patient dignity and patient empowerment has been shown to improve health care for populations often marginalized from the health care system and hence, may aid in the elimination of health disparities [17]. Patient-centered care, as defined by the IOM provides “…care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions” [18]. Its importance to health care delivery is well-documented. However, there has been little focus on the physician characteristics that are associated with the provision of this type of care. Historically, physicians have paid little attention to the influence of their own demographically based predispositions in their medical practice [19]. The medical literature also reflects the presumption that clinicians are neutral operators and are unaffected by personal variables [19]. While many studies have focused on the importance of the role that patient race, socioeconomic status (SES) and gender play in the physician–patient relationship [14], [19], [20], [21], [22], fewer studies have focused on the influence of physician race, SES and gender on attitudes toward patient centered care.

The studies that have focused on physician socio-demographic characteristics suggest that race concordant visits improve satisfaction for African American patients [20], [23] and that female physicians exhibit more empathy than their male counterparts [24], [25], [26]. However, it is unclear whether and how these findings are related to provider's attitudes toward patient-centered care. Additionally, very little research has documented the impact of physician SES on the physician–patient relationship although it has been suggested that physicians from lower SES backgrounds may be better equipped to care for patients who come from similar backgrounds [19].

Medical educators have recognized the importance of patient-centered care and its impact on the physician–patient relationship by instituting a variety of curricula to teach its tenets to medical students [2], [27]. These curricula may be more effective by understanding the individual characteristics that are associated with attitudes about patient-centered care. Thus the premise of this study is to examine how attitudes that may influence uptake of these behaviors may be related to the social background of the future physician [19]. We examine the relationship between socio-demographic characteristics (race, gender and SES) and attitudes toward patient-centered care in a national sample of 3191 African American and White 1st year medical students.

We were interested in examining African American student's attitudes toward patient-centered care given the body of work that has shown that provider-patient racial concordance is of particular salience for African American patients such that African American patients who see an African American provider are more likely to report greater satisfaction, feelings of respect and more participatory interactions—all important elements of patient-centered care [22], [28]. Given these findings, we thought it important to focus on documenting if attitudes toward patient-centered care among African American first year medical students exist so that future studies may seek to understand if these attitudes in medical school translate to behaviors in African American clinicians.

Section snippets

Data source

This study uses baseline data collected as part of Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES), a large longitudinal study of student experiences among first year medical students who matriculated in US medical schools in the fall of 2010 [29]. For detailed study protocol information, please refer to Supplemental Digital Content 1. Briefly, we sampled medical students using a stratified multistage sampling design. In the first stage, we sampled 49 medical schools from

Sample characteristics

Frequencies and summary statistics for sample characteristics were calculated for both African American and White students. Characteristics of the participants are presented in Table 2. There were a total of 3191 students in our sample and of these, 2890 were White and 301 were African American. African American students differed from their White counterparts in terms of gender, SES, and age. Women comprised 48% of White students and 66% of African American students. Nearly a quarter (23%) of

Discussion

While much attention has been paid to increasing physician's awareness of the role that a patients’ race, SES and gender play in health care, few studies have explored how the socio-demographic characteristics of health care providers affect their attitudes toward patient care. Patient-centered care is considered fundamental to cultural competence and theoretically has the potential to reduce racial/ethnic disparities in health care quality, because it directly addresses many of the

Funding/support

Support for this research was provided by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health under award number R01 HL085631.

Dr. Hardeman was additionally supported by the NHLBI Supplement to Promote Diversity in Health Related Research of the NIH under award number 3 R01 HL085631-02S2.

Other disclosures

None.

Ethical approval

This research study was approved by the human subjects Institutional Review Boards of the University of Minnesota (IRB no. 0905S66901, approved 6/5/2009) and Mayo Clinic (IRB no. 13-004612, approved 7/13/2013).

Disclaimer

The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs.

Previous presentations

A previous version of this paper was presented as a poster at the 2012 NIH Science of Eliminating Health Disparities Summit, National Harbor, Maryland.

Acknowledgements

Dr. Hardeman acknowledges the support of the Veterans Affairs Associated Health Postdoctoral Fellowship Training Program.

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