Tıp Fakültesi Öğrencilerinin Hasta-Hekim ilişkisi Yönelimleri ve Empati Düzeylerinin Değerlendirilmesi

Öz

Çağımızda hasta-hekim ilişkisinde sağlığın psikososyal boyutlarının dikkate alındığı, hastanın katılımını ve ortaklığını teşvik eden hasta merkezli yaklaşım giderek önem kazanmaktadır. Bu araştırmada, tıp fakültesi öğrencileri arasında hasta-hekim ilişkisi yönelimlerinin, ilişkili olduğu düşünülen bazı değişkenlerin incelenmesi ve empati düzeylerinin değerlendirilmesi amaçlanmıştır. Bu kesitsel çalışma, Mayıs-Haziran 2022 tarihleri arasında Eskişehir Osmangazi Üniversitesi (ESOGÜ) Tıp Fakültesi’nde öğrenim görmekte olan 1169 öğrenci üzerinde gerçekleştirilmiştir. Çalışmada, Hasta-hekim ilişkisi yönelimlerini belirlemek için Hasta-Hekim Yönelim Ölçeği (HHYÖ) ve empati düzeyleri belirlemek için Jefferson Doktor Empati Ölçeği’nden (JDEÖ) kullanılmıştır. İstatistiksel değerlendirmede, Mann-Whitney U, Kruskal-Wallis testleri, Spearman korelasyon ve Çoklu Lineer Regresyon analizleri kullanılmıştır. Katılımcıların 606’sı (%51.8) erkek, 679’u (%58.1) ise klinik öncesi sınıflarda öğrenim görmekte idi. Yaşları 18-52 arasında değişmekte olup yaş ortalaması 21.48±1.96 yıl idi. Çalışma grubunun HHYÖ’den aldıkları puanlar 1.36-5.36 arasında değişmekte olup ortalaması 3.68±0.54 iken JDEÖ ölçeğinden aldıkları puanlar 44-135 arasında değişmekte olup ortalaması 96.5±14.18 idi. HHYÖ’den elde edilen puanlar ile JDEÖ’den elde edilen puanlar arasında pozitif yönde zayıf bir korelasyon olduğu bulundu (r=0.297, p<0.001). Çoklu Lineer Regresyon analizi sonucunda B tipi kişiliğe sahip olma, hasta-hekim ilişkisi yönelimleri hakkında herhangi bir eğitim veya etkinliğe katılma ve artan empati düzeyleri ile HHYÖ’den alınan puanlar arasında ilişki olduğu saptandı (F=17.784, p<0.001). Tıp fakültesi öğrencilerinin hasta-hekim ilişkisi yönelimlerinin hasta merkezliliğe daha yakın olduğu tespit edilse de beklenen düzeyde olmadığı saptanmıştır.

Anahtar Kelimeler

• Tıp öğrencisi
• Doktor hasta ilişkisi
• Hasta merkezli
• Empati

Evaluation of Medical Students’ Orientations in the Patient-Physician Relationship and Empathy Levels

Öz

Today, a patient-centered approach that takes into account the psychosocial dimensions of health and promotes patient parrticipation and partnership in the patient relationship is becoming increasingly important. It is aimed to determine the orientations in the patient-physician relationship and some variables thought to be related to it, and to assess the level of empathy among medical students. This cross-sectional study was conducted among 1169 medical students at the Faculty of Medicine at Eskişehir Osmangazi University (ESOGU) between May-June 2022. In the study, the Patient-Physician Orientation Scale (PPOS) was used to measure the students’ orientations in the patient-physician relationship and the Jefferson Scale of Physician Empathy (JSPE) was used to measurement empathy levels. Mann-Whitney U, Kruskal-Wallis tests, Spearman correlation and Multiple Linear Regression analyses were used. Of the participants, 606 (51.8%) were male and 679 (58.1%) were in their preclinical years. Their ages ranged between 18-52 years with a mean of 21.48±1.96 years. The participants' scores on the PPOS ranged between 1.36-5.36 with a mean score of 3.68±0.54 points, while the scores on the JPES ranged between 44-135 with a mean score of 96.5±14.18 points. It was found that there was a weak positive correlation between the scores obtained from the PPOS and the scores obtained from the JPES (r=0.297, p<0.001). As a result of multiple linear regression analysis, it was found that having a Type B personality, participating in any training/activity related to the patient-physician relationship and an increased level of empathy were associated with scores obtained from PPOS (F=17.784, p<0.001). Although medical students' orientations in the patient-physician relationship was found to be closer to patient-centeredness, it was not at the expected level.

Anahtar Kelimeler

• Medical student
• Patient-physician relationship
• Patient-centered
• empathy

Kaynakça

1. 1. Ong LML, de Haes JCJM, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Soc Sci Med. 1995;40(7):903–18.
2. 2. Goold SD, Lipkin M. The doctor-patient relationship. J Gen Intern Med. 1999 ;14(S1):S26–33.
3. 3. Stewart MA. Effective physician-patient communication and health outcomes: a review. C Can Med Assoc J. 1995;152(9):1423.
4. 4. Maguire P. Key communication skills and how to acquire them. BMJ. 2002;325(7366):697–700.
5. 5. Barry CA. Patients’ unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000;320(7244):1246–50.
6. 6. Haskard Zolnierek KB, DiMatteo MR. Physician Communication and Patient Adherence to Treatment. Med Care. 2009 ;47(8):826–34.
7. 7. Kaba R, Sooriakumaran P. The evolution of the doctor-patient relationship. Int J Surg. 2007 ;5(1):57–65.
8. 8. Bensing J. Bridging the gap. Patient Educ Couns. 2000;39(1):17–25.

9. 9. Tate P, Frame F. The doctor’s communication handbook. 2019;
10. 10. Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51(7):1087–110.
11. 11. Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Educ Couns. 2016;99(12):1923–39.
12. 12. Robinson JH, Callister LC, Berry JA, Dearing KA. Patient‐centered care and adherence: Definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600–7.
13. 13. Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press; 2001.
14. 14. Olsson L, Hansson E, Ekman I, Karlsson J. A cost‐effectiveness study of a patient‐centred integrated care pathway. J Adv Nurs. 2009 ;65(8):1626–35.
15. 15. Stewart M, Ryan B, Bodea C. Is Patient-Centred Care Associated with Lower Diagnostic Costs? Healthc Policy | Polit Santé. 2011;6(4):27–31.
16. 16. Thomas PA, Kern DE, Hughes MT, Tackett SA, Chen BY. Curriculum development for medical education: a six-step approach. JHU press; 2022.
17. 17. Haidet P, Dains JE, Paterniti DA, Hechtel L, Chang T, Tseng E, et al. Medical student attitudes toward the doctor-patient relationship. Med Educ. 2002;36(6):568–74.
18. 18. Woloschuk W, Harasym PH, Temple W. Attitude change during medical school: a cohort study. Med Educ. 2004 ;38(5):522–34.
19. 19. Tsimtsiou Z, Kerasidou O, Efstathiou N, Papaharitou S, Hatzimouratidis K, Hatzichristou D. Medical students’ attitudes toward patient-centred care: a longitudinal survey. Med Educ. 2007;41(2):146–53.
20. 20. Yükseköğretim Kurulu. Mezuniyet Öncesi Tıp Eğitimi Ulusal Çekirdek Eğitim Programı- 2020.
21. 21. Irving P, Dickson D. Empathy: towards a conceptual framework for health professionals. Int J Health Care Qual Assur. 2004;17(4):212–20.
22. 22. Larson EB. Clinical Empathy as Emotional Labor in the Patient-Physician Relationship. JAMA. 2005 ;293(9):1100.
23. 23. Hojat M, Mangione S, Nasca TJ, Cohen MJM, Gonnella JS, Erdmann JB, et al. The Jefferson Scale of Physician Empathy: Development and Preliminary Psychometric Data. Educ Psychol Meas. 2001;61(2):349–65.
24. 24. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18(8):670–4.
25. 25. Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract. 2013;63(606):e76–84.
26. 26. Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(Suppl):S9-12.
27. 27. Bellet PS. The Importance of Empathy as an Interviewing Skill in Medicine. JAMA J Am Med Assoc. 1991;266(13):1831.
28. 28. Krupat E, Hiam CM, Fleming MZ, Freeman P. Patient-Centeredness and its Correlates among First Year Medical Students. Int J Psychiatry Med. 1999;29(3):347–56.
29. 29. Önal Ö, Tamam İ, Nur Eroğlu H. Bir Tıp Fakültesi 4-5-6. Sınıf Öğrencilerinin Hasta-Hekim İlişkisinde Hasta Merkezliliğe Yönelik Tutumları ve İlişkili Faktörler. SDÜ Tıp Fakültesi Derg. 2020;27(2):200–8.
30. 30. Özdemir S, Edirne T. Hasta-Hekim Yönelim Ölçeğinin (HHYÖ) Türkçeye uyarlanması. Tıp Eğitimi Dünyası. 2018;17(51):21–32.
31. 31. Hojat M, Mangione S, Nasca TJ, Rattner S, Erdmann JB, Gonnella JS, et al. An empirical study of decline in empathy in medical school. Med Educ. 2004;38(9):934–41.
32. 32. Gonullu I, Oztuna D. Turkish Adaptation Of The Student Version Of Jefferson Scale Of Physician Empathy. Marmara Med J. 2012;25(2).
33. 33. Lateef A, Dahar MA, Yousuf MI. Influence of type A and type B personality on academic achievement of university students. Glob Soc Sci Rev. 2019;4(2):109–18.
34. 34. Tontus H, Nebioglu S. Changing on Patient-Centred Attitudes on Same Students Group; A Qualitative Study. J Gen Pract. 2018;06(01):2.
35. 35. Bejarano G, Csiernik B, Young JJ, Stuber K, Zadro JR. Healthcare students’ attitudes towards patient centred care: a systematic review with meta-analysis. BMC Med Educ. 2022;22(1):324.
36. 36. Wahlqvist M, Gunnarsson RK, Dahlgren G, Nordgren S. Patient-centred attitudes among medical students: Gender and work experience in health care make a difference. Med Teach. 2010;32(4):e191–8.
37. 37. Wilcox M V, Orlando MS, Rand CS, Record J, Christmas C, Ziegelstein RC, et al. Medical students’ perceptions of the patient-centredness of the learning environment. Perspect Med Educ. 2016;6(1):44–50.
38. 38. Roter DL, Hall JA. Physician Gender and Patient-Centered Communication: A Critical Review of Empirical Research. Annu Rev Public Health. 2004;25(1):497–519.
39. 39. Ribeiro MMF, Krupat E, Amaral CFS. Brazilian medical students’ attitudes towards patient-centered care. Med Teach. 2007;29(6):e204–8.
40. 40. Shankar R, Dubey A, Mishra P, Deshpande V, Chandrasekhar T, Shivananda P. Student attitudes towards communication skills training in a medical college in Western Nepal. Educ Heal Chang Learn Pract. 2006 ;19(1):71–84.
41. 41. Ahmad W, Krupat E, Asma Y, Fatima N-E-, Attique R, Mahmood U, et al. Attitudes of medical students in Lahore, Pakistan towards the doctor–patient relationship. PeerJ. 2015;3:e1050.
42. 42. Batenburg V, Smal JA, Lodder A, Melker RA de. Are professional attitudes related to gender and medical specialty? Med Educ. 1999 ;33(7):489–92.
43. 43. Elfstrand Corlin T, Kajonius PJ, Kazemi A. The impact of personality on person‐centred care: a study of care staff in Swedish nursing homes. Int J Older People Nurs. 2017;12(2):e12132.
44. 44. Xu H, Xue R, Hao S. Attitudes toward patient-centeredness, personality and empathy of Chinese medical students. Pers Individ Dif. 2021;176:110777.
45. 45. Moon SW, Nam BW, Seo JS, Ryu EJ, Kweon HJ, Sohn IK, et al. Patient-Centeredness Associated with Personality Traits of Medical Students. Korean J Med Educ. 2006;18(1):77–85.
46. 46. Zainab Waheed, Sofi a Shehzad, Sabeen Rahim, Waleed Ahmad, Samir Khan Kabir, Hamid Hussain. Type A/B Personality in Undergraduate Medical Students and Group Pressure; Conformity. J Khyber Coll Dent. 2022;12(2):65–8.
47. 47. Chen C (Amy), Kotliar D, Drolet BC. Medical education in the United States: do residents feel prepared? Perspect Med Educ. 2015;4(4):181–5.
48. 48. Astin JA, Sierpina VS, Forys K, Clarridge B. Integration of the Biopsychosocial Model: Perspectives of Medical Students and Residents. Acad Med. 2008 ;83(1):20–7.
49. 49. Stepien KA, Baernstein A. Educating for empathy. J Gen Intern Med. 2006 ;21(5):524–30.
50. 50. Hojat M, Gonnella JS, Mangione S, Nasca TJ, Veloski JJ, Erdmann JB, et al. Empathy in medical students as related to academic performance, clinical competence and gender. Med Educ. 2002 ;36(6):522–7.