Longitudinal assessment of a novel curriculum’s impact on attitudes about psychosocial issues in ob/gyn and surgery

Jonathan Schaffir, MD; Nicole Verbeck, MPH; Doug Post, PhD; Kristen Carpenter, PhD; Jack Stevens, PhDThe Ohio State University College of Medicine, Columbus, Ohio.

Purpose: To determine the impact of a new curriculum integrating ob/gyn

and surgery on student opinions about psychosocial issues.

Background: A curriculum launched at the Ohio State University College

of Medicine replaced the traditional 6-8 week clerkships with an integrated

16-week rotation that covers elements of women’s health and surgical care,

with added emphasis on psychosocial issues. The new rotation included

weekly small groups with dedicated time to discuss psychosocial issues

relating to clinical scenarios in obstetrics, gynecology, and surgery.

Methods

Background Results Mean ratings of how important psychosocial issues are to topic(1= not at all; 5 = a great deal)

Small group topic Before curriculum

(n=39)

After curriculum

(n=24)

P value

Routine prenatal care 4.6(0.5) 4.6(0.5) 0.94

GI bleeding 3.8(1.0) 3.5(0.8) 0.27

Organ transplantation 4.6(0.7) 4.5(0.6) 0.70

STIs 4.5(0.9) 4.5(0.6) 0.95

Trauma 4.0(1.0) 3.7(0.9) 0.18

Acute abdomen 3.7(1.0) 3.7(1.0) 0.92

Breast cancer 4.6(0.6) 4.5(0.5) 0.43

Urinary incontinence 4.2(0.9) 4.2(0.9) 0.87

SICU care 4.1(0.9) 3.9(0.9) 0.37

Preterm delivery 4.4(0.7) 4.4(0.6) 0.71

Birth defects 4.8(0.5) 4.8(0.4) 0.85

Vascular surgery 3.8(0.8) 4.1(0.8) 0.09

•Scores demonstrating student interest in and comfort with psychosocial topics rose significantly after completing integrated clinical curriculum

•Ratings of importance and relevance of psychosocial topics were already high before completing clinical curriculum

•Whether because of instruction in early medical school or due to inherent bias, students entering the third year of medical school already share a high level of appreciation for the role that psychosocial issues play in surgical and reproductive care

Conclusions

StatementBefore

curriculum (n=39)

After curriculum

(n=24)

P value

My clinical experience has exposed me to sociocultural issues that impact patient care.

4.1 (0.7) 4.4 (0.5) 0.08

My clinical experience has exposed me to sociocultural issues that may impact the physician-patient relationship.

4.1 (0.7) 4.3 (0.6) 0.11

My clinical experience has exposed me to ways that sociocultural issues may influence aspects of treatment.

4.1 (0.8) 4.4 (0.6) 0.04

In a clinical setting, I have observed how a patient’s sociocultural background influenced health care decisions.

4.2 (0.7) 4.4 (0.6) 0.12

I have read journal articles, books, and/or other educational material on sociocultural aspects of health care.

3.8 (1.1) 3.7 (0.9) 0.73

I anticipate that psychological and sociocultural factors will be important issues to consider when I care for patients.

4.6 (0.6) 4.5 (0.6) 0.24

Psychosocial issues play an important role in providing treatment for women’s gynecological health.

4.5 (0.6) 4.6 (0.6) 0.57

Psychosocial issues are important aspects of caring for pregnant women.

4.6 (0.5) 4.8 (0.4) 0.41

It is important for me to know about my patient’s psychosocial concerns when I am planning and treating their surgical issues.

4.5 (0.8) 4.5 (0.6) 0.76

I am comfortable asking a patient about his or her feelings and moods.

4.1 (0.9) 4.5 (0.6) 0.08

I am comfortable asking a patient about his or her culture and family background.

4.0 (0.8) 4.2 (0.6) 0.31

I understand how sociocultural issues can impact my plan of care for my patients.

4.1 (0.7) 4.5 (0.5) 0.04

Subjects• Students before and after clinical instruction in obstetrics/ gynecology

and surgery

Intervention• “LSI” curriculum featuring integrated surgery and ob/gyn curriculum

with small group emphasis on psychosocial topics

Measurements• Psychological Medical Inventory for Students (PMI-S) scale

• Measures student interest and ability in psychosocial aspects of patient care

• Program evaluation re: psychosocial components• Ratings of exposure to and comfort with psychosocial topics

• Ratings of importance of psychosocial approach to topics covered in small groups

PMI-S scores

0

10

20

30

40

50

Before After

Exposure to clinical curriculum

Mea

n sc

ores

p<0.001

Mean ratings of agreement with statements (5 = strongly agree; 1 = strongly disagree)