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The Association of Direct Observation of Medical Students With Patient-Centered Care for Obesity

机译：患者以患者为中心护理的医学生直接观察与肥胖的协会

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Background and Objectives: Teaching medical students patient-centered approaches to weight loss counseling occurs in myriad ways. We examined lectures and direct faculty observation to see which was associated with better patient-centered care in medical students, measured by both self-perception and independent observer evaluation. Methods: Third- and fourth-year students attending one medical school were surveyed regarding their education in (1) weight loss and health behavior counseling, (2) obesity stigma, and (3) whether they had experienced direct faculty observation of their weight loss counseling. Several weeks later, the students were observed during a standardized patient encounter for obesity and an obesity-relevant comorbidity. A postencounter survey assessed overall student satisfaction with the encounter and with the care they provided. Independent coders rated their patient-centered communication using a validated measure. Results: There was no consistent association between any dependent variable and student ratings of adequacy of instruction, nor with instructional content. Direct faculty observation was not associated with overall encounter satisfaction or their overall patient-centeredness. However, experiences with direct faculty observation were significantly and positively associated with students’ perceptions of patient engagement (b=0.1, P=.05), and with independent coders’ ratings of student friendliness (b=0.13, P=.01), responsiveness (b=0.113, P=.03), and lower student anxiety (b=-0.1, P=.01). Conclusions: Independent observation and self-report of instruction adequacy and content had no consistent association with care quality. However, direct faculty observation predicted improvement in both student self-reports and independent observer ratings of students’ interpersonal quality of care. Further work is needed to define optimal methods of imparting patient-centered care.
机译：背景和目标：教学生物学生以患者为中心的减肥咨询方法发生在无数方面。我们审查了讲座和直接教师观察，以了解其在医学生更好的患者中心护理，通过自我认识和独立观察员评估来衡量。方法：在（1）减肥和健康行为咨询（2）肥胖症咨询，（2）肥胖的教育和第三年和第四年的学生接受了一名医学院的教育，（2）肥胖，（3）他们是否经历过重量损失的直接教师观察咨询。几周后，在标准化的患者遇到肥胖和肥胖相关的合并症中观察学生。 Postencounter调查评估了与遭遇的总体学生满意度以及他们提供的护理。独立编码器使用经过验证的措施额定患者中心的通信。结果：任何依赖变量与学生对指令充足的评分和教学内容之间没有一致的关联。直接教师观察与整体遇到满足或整体患者中心无关。然而，直接教师观察的经验与学生对患者接触的看法有了显着和积极的关联（B = 0.1，P = .05），以及与学生友好的独立编码器评级（B = 0.13，P = .01），响应能力（b = 0.113，p = .03）和较低的学生焦虑（b = -0.1，p = .01）。结论：教学充足和内容的独立观察和自我报告与护理质量无关。然而，直接教师观察预测学生自我报告和独立观察者的学生人际关系的级别素质的改善。需要进一步的工作来定义赋予患者中心护理的最佳方法。

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