1. •The PCPSS and PCRAS had good inter rater reliability.
•Two of three scorers agreed on 89% of the activities section prior
to group review.
•Surveys of AC members revealed that a vast majority (92%) use
the reported activities to assess patient centeredness.
•AC members can assign a score of 0-5 for key characteristics (KC)
•Mean score of KC was 4.44 with a SD 0.47.
•Both the PCPSS and the PCRAS showed a wider distribution of
scores, suggesting they are more discerning than assigning a
subjective score of KC (figure 1 and 2)
•No correlation between the scales and overall committee score
(chart 1)
Do Medical School Pre-Admission Patient Centered Scales Predict Patient Centeredness In Graduating Medical Students?
Nathan Beucke, MD, Rachel Brown, MBBS, Alison Martin, Med, Kyungbin Kwon PhD
University of Missouri-Columbia School of Medicine
Introduction DiscussionMethods Results
Conclusion
Background
OBJECTIVE: The University of Missouri School of Medicine
has developed key competencies for our graduates. Our
primary goal is the graduation of physicians who are able to
deliver effective patient-centered care.
r
MU2020: A Strategic Planning Process
Our goal is to admit applicants with the potential to develop these key
characteristics. By combining components of the current application
process with the observable qualities described above, we developed
numerical scales to assess patient centeredness in our applicants from
information provided in the AMCAS application.
Vision Statement for Admissions
We will admit students who:
are committed to providing safe and effective patient-centered care.
have demonstrated high ethical standards.
have shown compassion, respect and the ability to learn from and with others.
show the skills needed for academic success and life long learning, including
intellectual curiosity, the ability to work hard and the capacity to reflect and learn from
experience.
We will include in our selection students:
. from diverse backgrounds and those who are likely to serve the needs of the state
of Missouri, with special emphasis on the needs of underserved and rural
communities.
who are committed to generating new knowledge through health-related research
who are committed to teaching the next generation of physicians.
Our admissions process will be judged by others to be fair and transparent.
(Revised 2007.)
Clinical Curriculum
•Revised Mission and Vision Statement
•Assessing Patient Centeredness of personal
statement (PCPSS)
•Assessing Patient Centeredness of activities (PCRAS)
•Employ interview techniques to assess key characteristics
on a scale of 0-5
•A faculty/administration working group met and considered behaviors
and activities that indicate patient centeredness.
•The group read personal statements and reviewed the reported
activities submitted by applicants.
•The group then developed two numerical scales anchored with
descriptive statements; the Patient Centered Personal Statement Scale
(PCPSS) and the Patient Centered Reported Activities Scale (PCRAS).
•Three raters began using the scale in 2011. The group read 10
applications and assigned an individual score. The group then met and
discussed their scores. If there was variation in individual ranking the
group discussed and arrived at a consensus score.
•The process was repeated for the entire matriculating class.
•White Coat Ceremony
•Patient Centered Interviewing
•Evaluation Form includes PCC
•Patient attends case wrap ups
•Portfolio reflections
•Patient perspective adverse events
•Interdisciplinary patient safety and
QI course
•As cases revised, include PCC
•PC prompts in tutor guide
•Case writing PCC suggestions
•Create model PBL case for PCC
•“Pearls for success” from patients
•Integrate PCC into advanced
physical diagnosis course
Since there was no correlation between the scales and overall
committee score, our next step was to determine if there was any
correlation with our scales and student performance in the clinical
curriculum.
This would strengthen our case for using a standardized scale instead
of a subjective key characteristic score.
In our curriculum medical student’s patient centered care performance
was assessed in a simulated clinical setting with 4 simulated patient
scenarios at the end of their 3rd year clerkships.
PCC OSCE performance was measured by a final grade (exemplary,
satisfactory, and incomplete) and proportion of positive comments from
graders.
Unfortunately there was no significant relationship between PCC OSCE
performance.
•PCOE during family centered pediatrics rounds
•Family Medicine
•Legacy Teachers Luncheon
•Assessment form patient centered
•Surgery next
•PCC OSCE
•PCC Award at graduation
Our initial data demonstrated that both the PCRAS and PCPSS appeared to
be useful tools to utilize as part of the holistic review of applicants, and in
evaluating potential patient centeredness. We demonstrated that it is possible to
train raters to agree on the scale. The majority of our AC members believed
standard scales would be helpful in evaluating applicants more uniformly.
However, our scales did not show any significant relationship with PCC OSCE
performance
The next questions:
Is there a reliable way to assess patient centeredness at admissions?
Can new scales be developed based on OSCE results?
Does assessing patient centeredness at admissions lead to more patient
centered students?
0
5
10
15
20
25
0 1 2 3
Matriculants-EC2008
Essay Score
Figure 1: PCPSS
0
5
10
15
20
25
30
1 2 3 4 5 6 7
Matriculants-EnteringClass2008
Activities Scale Score
Figure 2: PCRAS
0
2
4
6
8
10
12
19 19.5 20 20.5 21 21.5 22 22.5
PatientCenteredScale(PCS)-PCPSS+PCRAS
Committee Score
Chart 1: Committee Score compared to PCS