Assessing Patient-centered Care: One Approach to Health Disparities Education

Abstract

BACKGROUNDPatient-centered care has been described as one approach to cultural competency education that could reduce racial and ethnic health disparities by preparing providers to deliver care that is respectful and responsive to the preferences of each patient. In order to evaluate the effectiveness of a curriculum in teaching patient-centered care (PCC) behaviors to medical students, we drew on the work of Kleinman, Eisenberg, and Good to develop a scale that could be embedded across cases in an objective structured clinical examination (OSCE).OBJECTIVETo compare the reliability, validity, and feasibility of an embedded patient-centered care scale with the use of a single culturally challenging case in measuring students′ use of PCC behaviors as part of a comprehensive OSCE.METHODSA total of 322 students from two California medical schools participated in the OSCE as beginning seniors. Cronbach’s alpha was used to assess the internal consistency of each approach. Construct validity was addressed by establishing convergent and divergent validity using the cultural challenge case total score and OSCE component scores. Feasibility assessment considered cost and training needs for the standardized patients (SPs).RESULTSMedical students demonstrated a moderate level of patient-centered skill (mean = 63%, SD = 11%). The PCC Scale demonstrated an acceptable level of internal consistency (alpha = 0.68) over the single case scale (alpha = 0.60). Both convergent and divergent validities were established through low to moderate correlation coefficients.DISCUSSIONThe insertion of PCC items across multiple cases in a comprehensive OSCE can provide a reliable estimate of students′ use of PCC behaviors without incurring extra costs associated with implementing a special cross-cultural OSCE. This approach is particularly feasible when an OSCE is already part of the standard assessment of clinical skills. Reliability may be increased with an additional investment in SP training.

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review

“…With respect to the domain of 'focused interview,' we didn't achieve agreement (ICC À0.12). This finding is explained by the absence of any description of the 'focused interview' domain in all of those papers [26,27,33,34,45,49]. Full agreement was reached in only three of the included papers.…”

“…Four studies reported short and long case scenarios with obviously different durations [11,31,32,37], in contrast to nine studies which did not report station length at all [15,[47][48][49][50][51][52][53][54][55]. Sixteen studies reported references to validity and reliability studies of the assessment forms being used [11,15,24,26,27,30,39,40,[42][43][44][45][46][52][53][54], whilst six studies reported only validity ( [31,33,37,50,55], and twelve reported only reliability [25,28,32,[34][35][36]38,41,[47][48][49]51]. Two studies compared assessments of medical student CS across different institutions [4...…”

“…In two studies students were assessed only by SP raters. [50,51] In eight studies students were assessed by examiners and by SP raters [11,26,31,34,36,45,52,53]. In the remaining 24 studies students were assessed by examiners alone.…”

“…Fourteen papers reported the use of checklists or global rating scales [15,28,29,34,35,38,41,43,45,46,[50][51][52]55], while global rating scales were described in 3 of the 14 papers by Park [34], Wass [43] and Hodges [15], respectively, in Park's paper students were assessed by SP raters only [34]. However we identified 11 papers not reporting any measurement instruments in terms of a documented list of items described in the paper or an appendix [24,25,30,32,36,39,42,44,47,53,54].…”

Creating a Sustainable Cancer Workforce: Focus on Disparities and Cultural Competence

“…(Chun 2010;Echeverri, Brookover et al 2010;Kamaka 2010;Wilkerson, Fung et al 2010;Crenshaw, Shewchuk et al 2011) These evolving tools will enrich the health care provider and enhance the relationship between diverse patients and the health care system. The next five years should be exciting as these tools, guides, and curricula emerge.…”