Do Gold Humanism Honor Society Inductees Differ From Their Peers in Empathy, Patient-Centeredness, Tolerance of Ambiguity, Coping Style, and Perception of the Learning Environment?

Construct: Induction into the Gold Humanism Honor Society (GHHS) during medical school is recognized as an indicator of humanistic orientation and behavior. Various attitudes and interpersonal orientations including empathy and patient-centeredness have been posited to translate into behaviors constituting humanistic care. BACKGROUND: To our knowledge there has never been a longitudinal, multi-institutional empirical study of the attitudinal and interpersonal orientations correlated with GHHS membership status. APPROACH: We used the American Medical Association Learning Environment Study (LES) data set to explore attitudinal correlates associated with students whose behaviors are recognized by their peers as being exceptionally humanistic. Specifically, we examined whether empathy, patient-centeredness, tolerance of ambiguity, coping style, and perceptions of the learning environment are associated with GHHS membership status. We further considered to what extent GHHS members arrive in medical school with these attitudinal correlates and to what extent they change and evolve differentially among GHHS members compared to their non-GHHS peers. Between 2011 and 2015, 585 students from 13 North American medical schools with GHHS chapters participated in the LES, a longitudinal cohort study using a battery of validated psychometric measures including the Jefferson Scale of Empathy, Patient-Practitioner Orientation Scale and Tolerance of Ambiguity Questionnaire. In the final survey administration, students self-identified as GHHS inductees or not (non-GHHS). T tests, effect sizes, and longitudinal generalized mixed-effects models examined the differences between GHHS and non-GHHS students. RESULTS: Students inducted into GHHS scored significantly higher on average over 4 years than non-GHHS inductees on clinical empathy, patient-centered beliefs, and tolerance of ambiguity. GHHS students reported higher levels of empathy and patient-centeredness at medical school matriculation. This difference persists in the 4th year of medical school and when controlling for time, race, gender, and school. CONCLUSIONS: GHHS inductees enter medical school with different attitudes and beliefs than their non-GHHS classmates. Although humanistic attitudes and beliefs vary over time during students' 4 years, the gap between the two groups remains constant. Medical schools may want to consider selecting for specific humanistic traits during admissions as well as fostering the development of humanism through curricular interventions.

Medical Student Perceptions of the Learning Environment at the End of the First Year: A 28-Medical School Collaborative.

PURPOSE: Accreditation and professional organizations have recognized the importance of measuring medical students' perceptions of the learning environment, which influences well-being and professional competency development, to optimize professional development. This study was conducted to explore interactions between students' perceptions of the medical school learning environment, student demographic variables, and students' professional attributes of empathy, coping, tolerance of ambiguity, and patient-centeredness to provide ideas for improving the learning environment. METHOD: Twenty-eight medical schools at 38 campuses recruited 4,664 entering medical students to participate in the two-cohort longitudinal study (2010-2014 or 2011-2015). The authors employed chi-square tests and analysis of variance to examine the relationship between Medical School Learning Environment Survey (MSLES) scores and student characteristics. The authors used mixed-effects models with random school and campus effects to test the overall variances accounted for in MSLES scores at the end of the first year of medical school. RESULTS: Student attributes and demographic characteristics differed significantly across schools but accounted for only 2.2% of the total variance in MSLES scores. Medical school campus explained 15.6% of the variance in MSLES scores. CONCLUSIONS: At year's end, students' perceptions toward the learning environment, as reported on the MSLES, differed significantly according to the medical school campus where they trained. Further studies are needed to identify specific factors, such as grading policies, administrative support, and existence of learning communities, which may influence perceptions of the learning environment at various schools. Identifying such variables would assist schools in developing a positive learning environment.

Family medicine in the Russian far East.

BACKGROUND AND OBJECTIVES: Over the last decade, Russia and other former Soviet states have attempted to move from a fragmented health care system dominated by specialty and hospital care to one emphasizing primary care and prevention through the introduction of family medicine. This report describes the development of family medicine in Russia's Far East region. METHODS: The Far East was one of the first places in Russia to develop family medicine education. Early interaction with the United States and adoption of an American training model allowed rapid development of the training program. The Russian Ministry of Health issued a health order in 1992 to transition the organization of primary care in Russia to a family medicine model. RESULTS: There are now 15 family medicine training programs in Russia, with several now established in the Far East. Introducing family medicine effectively into an "entrenched" medical system that does not reward prevention has proven difficult for reasons including lack of funding and training that does not fully prepare physicians for practice in their geographic area. CONCLUSIONS: Family medicine training has been developed in the Russian Far East with some success, but a number of challenges still remain.

From traditional to patient-centered learning: curriculum change as an intervention for changing institutional culture and promoting professionalism in undergraduate medical education.

The authors reframe a curriculum change from a traditional lecture-based to an integrated patient-centered approach as an intervention for changing the culture and hidden curriculum of an institution in ways that promote professionalism. Within this context, the authors articulate some of the inherent process and relational factors brought about by these curricular changes that are essential elements of this intervention process. In 1998 the University of North Dakota School of Medicine and Health Sciences (UNDSMHS) introduced a new preclinical patient-centered learning (PCL) curriculum for first- and second-year medical students. Case-based, small-group learning forms the critical foundation of the PCL process, and an integrated basic and clinical science didactic component supports this process. At the student level, the case-based PCL process generates innovative opportunities for professionalism education from the explicitly articulated formal content that arises naturally from the cases, but more importantly from the implicit values inherent to the PCL small-group process itself--humanism, accountability, pursuit of excellence, and altruism. Further, the organizational changes necessary for the transformation to the PCL curriculum required process changes at student, faculty, and administrative levels that have resulted in a cultural shift toward relationship centeredness within the institution. The authors describe the evolution and structure of the PCL curriculum at UNDSMHS and how this curricular transformation has served as an intervention that promotes professionalism and institutional culture change through (1) processes at the student level that present new opportunities for professionalism education, and (2) processes at student, faculty, administrative, and institutional levels that have created an institutional culture that supports, models, and promotes relationship-centered professional values.