Assessment of attitudes related to humanization of assistance by medical students

Cardoso, Higor Chagas; Pereira, Edna Regina Silva; Soares, Viviane; Soares, Guilherme Antônio Ferreira de Sena; Cardoso, Vinícius Chagas; Rabahi, Marcelo Fouad

doi:10.1590/1981-5271v47.3-2023-0091.ING

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ORIGINAL ARTICLE • Rev. bras. educ. med. 47 (3) • 2023 • https://doi.org/10.1590/1981-5271v47.3-2023-0091.ING copy

Assessment of attitudes related to humanization of assistance by medical students

Avaliação de atitudes relacionadas ao atendimento humanizado pelos estudantes de Medicina

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

Typical medical care has been characterized by professional and disease-centered attitudes, with little concern for focusing on the patient’s psychosocial context and expectations. However, the medical care that seeks to more globally encompass the patient’s perspective has shown to bring greater benefits.

Objective:

To evaluate the attitudes of medical students regarding the physician-patient relationship.

Methods:

This is a cross-sectional study that evaluated the attitudes of students in the 4^th semester of the medical course in relation to patient care based on the application of the Patient-Practitioner Orientation Scale and a questionnaire with sociodemographic and curricular characteristics. Data were analyzed using the Statistical Package for Social Science (SPSS) software and the Mann-Whitney test, Kruskal-Wallis test with Dunn’s post hoc, and Chi-square test.

Results:

A total of 83 medical students participated in the study, with a prevalence of female students (74.7%), and those who declared a family income of less than US$ 2,140 (43.0%), as well as those who professed the Catholic religion (53.0%). The majority of students (85.5%) had attitudes centered on the physician and the disease (mean PPOS scores <4.57), with scores in the caring domain higher than those in the sharing domain. The variables gender, family income, student financial aid, and religion showed a positive association (p≤0.05) with PPOS scores related to patient-centered attitudes. There were no statistically significant associations of PPOS scores with the variables age group, city of origin, undergraduate research activities, extracurricular internships, artistic activities, personal and family history of serious illness, and parental level of schooling.

Conclusion:

The present study showed that the assessed medical students had attitudes centered on the physician and on the disease, with mean PPOS scores below the range related to attitudes of humanized medicine.

Keywords:
Humanization of Assistance; Education; Medical; Undergraduate; Physician-Patient Relations; Patient-Centered Care; Clinical Competence

Sociodemographic and curricular characteristics	Frequency	(%)
Gender
Female	62	74.7
Male	21	25.3
Age range
18 to 20 years	39	47.0
21 to 25 years	39	47.0
26 to 30 years	04	6.0
Family income
< US$ 2,140	36	43.0
Between US$ 2,140 and US$ 4,280	27	32.5
Between US$ 4,280 and US$ 8,560	13	15.7
> US$ 8,560	07	8.4
Place of origin
Goiânia	44	55.5
Brasília	03	3.6
Other	36	40.9
Religion
Catholic	44	53.0
Evangelical	22	26.5
Spiritualist	10	12.0
Buddhist	01	1.2
Other	02	2.4
None	04	4.8
Student Scholarship programs
Yes	23	27.7
No	60	72.3
Extracurricular internships
Yes	24	28.9
No	59	71.1
Artistic Activity
Yes	24	28.9
No	59	71.1
Undergraduate Research
Yes	68	81.9
No	15	18.1
Personal Illness
Yes	04	4.8
No	79	95.2
Family Illness
Yes	42	50.6
No	41	49.4
Parental level of schooling
Elementary	11	13.3
High School	23	27.7
Higher Education	49	59.0
Parent with a medical degree
Yes	06	7.2
No	77	92.8
Intended specialty
Clinical	33	39.7
Surgical	21	25.3
Clinical and Surgical	01	1.2
Does not know	28	33.7

Scores	Frequency	%
Total PPOS
<4.57*	71	85.5
4.57-4.99⁺	12	14.5
≥5.00^§	0	0
Caring
<4.57*	64	77.1
4.57-4.99⁺	12	14.5
≥5.00^§	7	8.4
Caring - psychosocial context
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	59	71.1
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	17	20.5
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	7	8.4
Caring - patient’s perspective
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	58	69.9
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	18	21.7
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	7	8.4
Sharing
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	74	89.2
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	5	6.0
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	4	4.8
Sharing information
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	72	86.7
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	5	6.0
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	6	7.2
Sharing power and responsibility
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	48	57.8
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	32	38.6
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	3	3.6

Sociodemographic and curricular characteristics	Mean total PPOS (SD)	Caring Mean (SD)	Caring -psychosocial context Mean (SD)	Caring - patient perspective Mean (SD)	Sharing Mean (SD)	Sharing information Mean (SD)	Sharing power and responsibility Mean (SD)
Age range
18 to 20 years	4.13 (0.50)	4.32 (0.51)	4.49 (0.63)	4.24 (0.70)	3.95 (0.71)	3.66 (0.89)	4.17 (0.74)
21 to 25 years	4.09 (0.43)	4.21 (0.61)	4.28 (0.66)	4.17 (0.77)	3.97 (0.53)	3.60 (0.81)	4.28 (0.88)
26 to 30 years	4.00 (0.30)	4.27 (0.23)	4.07 (0.43)	4.37 (0.32)	3.73 (0.55)	3.05 (0.57)	4.28 (0.73)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.887	0.723	0.110	0.553	0.925	0.470	0.707
Gender
Female	3.96 (0.49)	4.08 (0.66)	4.51 (0.87)	3.87 (0.77)	3.84 (0.59)	3.49 (0.91)	4.12 (0.55)
Male	4.15 (0.44)	4.33 (0.49)	4.31 (0.54)	4.33 (0.66)	3.98 (0.63)	3.64 (0.83)	4.26 (0.70)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.121	0.101	0.442	0.011	0.556	0.666	0.248
Family income
< US$ 2,140	4.09 (0.38)	4.19 (0.53)	4.20 (0.60)	4.19 (0.68)	3.98 (0.55)	3.68 (0.79)	4.23 (0.58)
Between US$ 2,140 and US$ 4,280	4.11 (0.48)	4.30 (0.56)	4.51 (0.72)	4.19 (0.77)	3.93 (0.69)	3.60 (0.95)	4.20 (0.72)
Between US$ 4,280 and US$ 8,560	4.20 (0.55)	4.54 (0.49)	4.64 (0.46)	4.48 (0.67)	3.87 (0.68)	3.38 (0.72)	4.26 (0.86)
> US$ 8,560	3.98 (0.60)	4.00 (0.55)	4.14 (0.54)	3.93 (0.76)	3.95 (0.68)	3.57 (1.01)	4.26 (0.59)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.549	0.033	0.09	0.266	0.565	0.670	0.595
Place of origin
Goiânia	4.13 (0.50)	4.34 (0.54)	4.37 (0.63)	4.29 (0.63)	3.92 (0.67)	3.57 (0.89)	4.20 (0.71)
Brasília	4.20 (0.50)	4.48 (0.39)	4.33 (0.00)	4.56 (0.59)	3.93 (0.63)	3.25 (0.90)	4.47 (0.61)
Others	4.07 (0.41)	4.17 (0.55)	4.29 (0.67)	4.11 (0.80)	3.98 (0.58)	3.66 (0.80)	4.24 (0.63)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.658	0.658	0.389	0.612	0.612	0.640	0.651
Student Scholarship programs
Yes	3.96 (0.49)	4.12 (0.63)	4.13 (0.57)	4.12 (0.91)	3.80 (0.61)	3.41 (0.63)	4.12 (0.78)
No	4.16 (0.44)	4.32 (0.50)	4.46 (0.64)	4.25 (0.63)	4.00 (0.62)	3.67 (0.91)	4.27 (0.62)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.157	0.183	0.047	0.519	0.219	0.206	0.619
Undergraduate research activities
Yes	4.10 (0.47)	4.26 (0.55)	4.37 (0.67)	4.21 (0.71)	3.93 (0.63)	3.58 (0.84)	4.22 (0.70)
No	4.13 (0.41)	4.27 (0.54)	4.33 (0.45)	4.24 (0.74)	3.99 (0.58)	3.68 (0.89)	4.24 (0.51)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.972	0.938	0.828	0.953	0.665	0.436	0.789
Extracurricular internships
Yes	4.10 (0.51)	4.23 (0.55)	4.41 (0.66)	4.14 (0.65)	3.97 (0.71)	3.56 (0.86)	4.30 (0.78)
No	4.11 (0.44)	4.28 (0.55)	4.34 (0.63)	4.25 (0.74)	3.93 (0.58)	3.61 (0.84)	4.20 (0.62)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.880	0.625	0.397	0.621	0.580	0.984	0.355
Artistic activity
Yes	4.08 (0.49)	4.15 (0.55)	4.28 (0.38)	4.08 (0.75)	4.01 (0.61)	3.59 (0.82)	4.35 (0.61)
No	4.11 (0.44)	4.31 (0.54)	4.40 (0.72)	4.27 (0.70)	3.92 (0.63)	3.60 (0.86)	4.18 (0.69)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.896	0.215	0.228	0.301	0.365	0.896	0.210
Personal Illness
Yes	4.19 (0.25)	4.14 (0.47)	4.17 (0.84)	4.13 (0.34)	4.25 (0.11)	3.88 (0.63)	4.55 (0.41)
No	4.10 (0.46)	4.27 (0.55)	4.38 (0.63)	4.22 (0.73)	3.93 (0.63)	3.58 (0.85)	4.21 (0.67)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.586	0.704	0.798	0.644	0.132	0.416	0.305
Family Illness
Yes	4.09 (0.49)	4.18 (0.56)	4.40 (0.67)	4.08 (0.72)	3.99 (0.60)	3.58 (0.85)	4.33 (0.64)
No	4.12 (0.42)	4.35 (0.52)	4.33 (0.61)	4.36 (0.69)	3.90 (0.64)	3.61 (0.85)	4.13 (0.68)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.949	0.162	0.357	0.083	0.256	0.931	0.096
Parental level of schooling
Primary	4.04 (0.48)	4.17 (0.74)	4.27 (0.83)	4.12 (0.80)	3.91 (0.56)	3.57 (0.83)	4.20 (0.68)
Secondary	4.16 (031)	4.23 (0.45)	4.23 (0.52)	4.22 (0.70)	4.09 (0.50)	3.72 (0.72)	4.38 (0.52)
Higher	4.09 (0.51)	4.21 (0.55)	4.45 (0.64)	4.23 (0.72)	3.88 (0.68)	3.55 (0.91)	4.16 (0.72)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.339	0.782	0.082	0.904	0.842	0.663	0.950
Parent with a medical degree
Yes	4.01 (0.65)	4.31 (0.63)	4.44 (0.27)	4.24 (0.84)	3.72 (0.73)	3.33 (0.97)	4.03 (0.66)
No	4.11 (0.44)	4.26 (0.54)	4.36 (0.66)	4.21 (0.71)	3.96 (0.61)	3.62 (0.84)	4.24 (0.67)
p ^a a Data for p≤ 0.05 statistically. Source: created by the authors.	0.993	0.486	0.500	0.602	0.537	0.764	0.386

PPOS score domains	Catholic (n=44) n (%)	Evangelical (n=22) n (%)	Spiritualist (n=10) n (%)	Buddhist (n=01) n (%)	Others (n=02) n (%)	None (n=04) n (%)	p ^d d Data for p≤ 0.05 statistically significant;
Total PPOS scores
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	39 (54.9)	21 (29.6)	08 (11.3)	0 (0)	01 (1.4)	02 (2.8)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	05 (41.7)	01 (8.3)	02 (16.7)	01 (8.3)	01 (8.3)	02 (16.7)	0.05
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Caring
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	37 (57.8)	15 (23.4)	08 (12.5)	01 (1.6)	01 (1.6)	02 (3.1)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	03 (25.0)	07 (58.3)	01 (8.3)	0 (0)	01 (8.3)	0 (0)	0.063
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (57.1)	0 (0)	01 (14.3)	0 (0)	0 (0)	02 (28.6)
Caring - psychosocial context
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	30 (50.8)	16 (27.1)	09 (15.3)	01 (1.7)	01 (1.7)	02 (3.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	12 (70.6)	04 (23.5)	0 (0)	0 (0)	01 (5.9)	0 (0)	0.171
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	02 (28.6)	02 (28.6)	01 (14.3)	0 (0)	0 (0)	02 (28.6)
Caring patient’s perspective
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	35 (60.3)	11 (19.0)	08 (13.8)	01 (1.7)	01 (1.7)	02 (3.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	05 (27.8)	11 (61.1)	0 (0)	0 (0)	0 (0)	02 (11.1)	0.005
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (57.1)	0 (0)	02 (28.6)	0 (0)	01 (14.3)	0 (0)
Sharing
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	39 (52.7)	22 (29.7)	08 (10.8)	0 (0)	01 (1.4)	04 (5.4)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	03 (60.0)	0 (0)	01 (20.0)	01 (20.0)	0 (0)	0 (0)	0.102
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	02 (50.0)	0 (0)	01 (25.0)	0 90)	01 (25.0)	0 (0)
Sharing information
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	38 (52.8)	21 (29.2)	08 (11.1)	0 (0)	01 (1.4)	04 (5.6)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	02 (40.0)	01 (20.0)	0 (0)	01 (20.0)	01 (20.0)	0 (0)	0.087
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	04 (66.7)	0 (0)	02 (33.3)	0 (0)	0 (0)	0 (0)
Sharing power and responsibility
<4.57^a a PPOS scores < 4.57 = physician-centered and disease-centered attitudes;	29 (60.4)	12 (25.0)	05 (10.4)	0 (0)	01 (2.1)	01 (2.1)
4.57-4.99^b b PPOS scores between 4.57 and 4.99 = moderately patient-centered attitudes;	14 (43.8)	09 (28.1)	05 (15.6)	01 (3.1)	0 (0)	03 (9.4)	0.304
≥5.00^c c PPOS scores≥ 5.00 = patient-centered attitudes;	01 (33.3)	01 (33.3)	0 (0)	0 (0)	01 (33.3)	0 (0)

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