Thursday, July 2, 2015

The effect of a longitudinal curriculum teaching pediatric residents patient- and family-centered care (PFCC) on physician ‘centeredness’

Keith Mann, MD, MEd
Children's Mercy Hospital

Introduction: A longitudinal patient and family centered care (PFCC) curriculum was developed and implemented in July 2009 at Children’s Mercy Hospitals and Clinics pediatric residency program. The impact of the curriculum on the self-perception of patient centered behavior and practices was assessed via the patient practitioner orientation scale (PPOS).

Methods: A quasi-experimental, non-randomized control group, pre- and post-test design was used. The experimental group of 24 interns filled out the PPOS in June 2009, prior to residency. The control group of 17 graduating residents, having never been exposed to the PFCC curriculum, also took the PPOS in June 2009. After completing two years of residency and the vast majority of the curriculum, the experimental group of interns again completed the PPOS in July 2011. The curriculum was assessed by comparing mean total and subscale PPOS scores.
Results: The mean (±SD) total PPOS score for the interns was 4.6 (± 0.43). Seventeen female interns (4.8 ± 0.36) were more patient-centered than 6 male interns (4.2 ± 0.38) (p=0.0054) and scored significantly higher than males (4.8±0.39 vs. 4.0±0.38) in the sharing domain (p=0.0008). There was no difference in baseline total or subscale PPOS scores between the experimental and control group. The mean total PPOS score for the experimental group after completion of the curriculum was 4.55 (p=0.45), reflecting no change in perceived centeredness.
Discussion: Most pediatric residents at a single children’s hospital perceive themselves as patient- and family centered at the start of residency and remain so throughout residency. There was no change in perceived centeredness after a longitudinal curriculum teaching the behaviors and skills needed to practice PFCC. Possible reasons for the lack of change include small sample size, high baseline level of perceived patient centeredness, and counter-influence of the hidden curriculum present in many clinical settings.
Conclusion: The necessary behaviors and skills needed to practice PFCC are not easy to teach in a formal curriculum and not easy to measure. Many of these skills are learned through mentors while caring for patients. The impact of any formal curriculum may be limited by hidden curriculum present in most clinical settings.