Can changes in the principal clinical year prevent the erosion of students' patient-centered beliefs?

The third year of medical school, in which students traditionally receive their first immersion into hospital-based clinical medicine, often results in a degradation of attitudes toward medicine and patient care. The authors present data collected in the 2005-2006 academic year from a pilot program aimed at enhancing this experience, thereby enabling students to resist these negative influences.

Thirty-two Harvard Medical School students, who spent their entire principal clinical experience (PCE) at one of three clinical sites (PCE group), completed the Patient-Practitioner Orientation Scale (PPOS), a measure of patient-centered attitudes, at the beginning of the year. They completed the PPOS again at year's end as well as the Community, Curriculum, and Culture (C3) hidden curriculum measure of patient-centered clinical experiences. Their responses on these measures were compared with those of a traditional-rotation control group that moved from site to site.

At the beginning of the year, no PPOS differences were found within PCE groups or between PCE and control students. Traditional students' attitudes became significantly less patient-centered at year's end, whereas PCE students' attitudes did not change. PCE students reported more support for their patient-centered behaviors, and, across all students, C3 scores and changes in PPOS scores were significantly correlated.

Innovations in clinical education may help inoculate medical students against the degradation of attitudes. Although this research was a test of a small pilot program, the consistent pattern of findings across those clinical sites and educational models studied provides suggestive evidence that the oft-cited negative impacts of the principal clinical year are not inevitable.