•The PCPSS and PCRAS had good inter rater reliability.

•Two of three scorers agreed on 89% of the activities section prior

to group review.

•Surveys of AC members revealed that a vast majority (92%) use

the reported activities to assess patient centeredness.

•AC members can assign a score of 0-5 for key characteristics (KC)

•Mean score of KC was 4.44 with a SD 0.47.

•Both the PCPSS and the PCRAS showed a wider distribution of

scores, suggesting they are more discerning than assigning a

subjective score of KC (figure 1 and 2)

•No correlation between the scales and overall committee score

(chart 1)

Do Medical School Pre-Admission Patient Centered Scales Predict Patient Centeredness In Graduating Medical Students?

Nathan Beucke, MD, Rachel Brown, MBBS, Alison Martin, Med, Kyungbin Kwon PhD

University of Missouri-Columbia School of Medicine

Introduction DiscussionMethods Results

Conclusion

Background

OBJECTIVE: The University of Missouri School of Medicine

has developed key competencies for our graduates. Our

primary goal is the graduation of physicians who are able to

deliver effective patient-centered care.

r

MU2020: A Strategic Planning Process

Our goal is to admit applicants with the potential to develop these key

characteristics. By combining components of the current application

process with the observable qualities described above, we developed

numerical scales to assess patient centeredness in our applicants from

information provided in the AMCAS application.

Vision Statement for Admissions

We will admit students who:

are committed to providing safe and effective patient-centered care.have demonstrated high ethical standards.have shown compassion, respect and the ability to learn from and with others. show the skills needed for academic success and life long learning, including intellectual curiosity, the ability to work hard and the capacity to reflect and learn from experience.

We will include in our selection students:

. from diverse backgrounds and those who are likely to serve the needs of the state of Missouri, with special emphasis on the needs of underserved and rural communities. who are committed to generating new knowledge through health-related researchwho are committed to teaching the next generation of physicians.

Our admissions process will be judged by others to be fair and transparent. (Revised 2007.)

Clinical Curriculum

•Revised Mission and Vision Statement

•Assessing Patient Centeredness of personal

statement (PCPSS)

•Assessing Patient Centeredness of activities (PCRAS)

•Employ interview techniques to assess key characteristics

on a scale of 0-5

•A faculty/administration working group met and considered behaviors

and activities that indicate patient centeredness.

•The group read personal statements and reviewed the reported

activities submitted by applicants.

•The group then developed two numerical scales anchored with

descriptive statements; the Patient Centered Personal Statement Scale

(PCPSS) and the Patient Centered Reported Activities Scale (PCRAS).

•Three raters began using the scale in 2011. The group read 10

applications and assigned an individual score. The group then met and

discussed their scores. If there was variation in individual ranking the

group discussed and arrived at a consensus score.

•The process was repeated for the entire matriculating class.

•White Coat Ceremony

•Patient Centered Interviewing

•Evaluation Form includes PCC

•Patient attends case wrap ups

•Portfolio reflections

•Patient perspective adverse events

•Interdisciplinary patient safety and

QI course

•As cases revised, include PCC

•PC prompts in tutor guide

•Case writing PCC suggestions

•Create model PBL case for PCC

•“Pearls for success” from patients

•Integrate PCC into advanced

physical diagnosis course

Since there was no correlation between the scales and overall

committee score, our next step was to determine if there was any

correlation with our scales and student performance in the clinical

curriculum.

This would strengthen our case for using a standardized scale instead

of a subjective key characteristic score.

In our curriculum medical student’s patient centered care performance

was assessed in a simulated clinical setting with 4 simulated patient

scenarios at the end of their 3rd year clerkships.

PCC OSCE performance was measured by a final grade (exemplary,

satisfactory, and incomplete) and proportion of positive comments from

graders.

Unfortunately there was no significant relationship between PCC OSCE

performance.

•PCOE during family centered pediatrics rounds•Family Medicine•Legacy Teachers Luncheon•Assessment form patient centered

•Surgery next•PCC OSCE•PCC Award at graduation

Our initial data demonstrated that both the PCRAS and PCPSS appeared to be useful tools to utilize as part of the holistic review of applicants, and in evaluating potential patient centeredness. We demonstrated that it is possible to train raters to agree on the scale. The majority of our AC members believed standard scales would be helpful in evaluating applicants more uniformly. However, our scales did not show any significant relationship with PCC OSCE performance

The next questions:Is there a reliable way to assess patient centeredness at admissions?Can new scales be developed based on OSCE results?Does assessing patient centeredness at admissions lead to more patient centered students?

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Figure 1: PCPSS

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Figure 2: PCRAS

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Chart 1: Committee Score compared to PCS