1. Institutional professionalism culture of patient-centredness in Sri Lankan medical schools
Rasnayake Mudiyanse1
Madawa Chandratilake2
Shamila de Silva2
1 Faculty of Medicine, University of Peradeniya, Sri Lanka
2Faculty of Medicine, University of Kelaniya, Sri Lanka

2. BACKGROUND Patient-centredness
Working definition:
Acknowledgement of the patient as a person with unique needs and life history
(Stewart 1984)

3. BACKGROUND Patient-centredness
‘Good doctors’ make the care of their patients their first concern.
(GMC Good Medical Practice 2009)
Professionalism is the basis of medicine’s contract with society.
 patient autonomy
(ABIM 2002)
‘Patient practice’
(SLMC)

4. BACKGROUND Patient-centredness
‘Old’ Professionalism
‘New’ Professionalism
Detachment
Empathy
Paternalism
Emotional Engagement
Restricted communication with patients 
Open Communication
Patient-centeredness
Medical beneficence as the most prominent ethical principle
Patient autonomy as the most prominent ethical principle
(Borgstrom et al. 2010)

5. BACKGROUND Cultural context
e.g. Cultural dimensions theory (Hofstede 2010)
Western cultures
(UK, Europe and North America)
Eastern cultures
(Arabic Gulf region, Asian subcontinent )
Individualists
Collectivists
Unequal power distribution in-between social strata is unacceptable
Unequal power distribution in-between social strata is acceptable

6. METHODS Study design: Cross sectional descriptive study using self-
administered paper-based C3 instrument
Setting:
Faculty of Medicine, University of Kelaniya
Faculty of Medicine, University of Peradeniya
Subjects:
Final-year medical students (n=378)
Ethics:
Ethics committees of both faculties

7. METHODS
The instrument: Communication, Curriculum and Culture C3 Instrument
Use: Characterize and understand the institutional hidden curriculum on patient-centredness
(Haidet et al 2005 Characterizing the Patient-Centeredness of Hidden
Curricula in Medical Schools: Development and Validation of a
New Measure. Academic Medicine; 80:44–50.)

8. METHODS C3 instrument
Validated to be used in Sri Lanka

9. RESULTS Response rate: 340/378 (90%)
Internal consistency (Cronbach alpha):
Overall: 0.84
Domains:
‘Role model’ (high)
‘Student experience’ (moderate)
‘Support’ (moderate)
 The findings can be interpreted with acceptable credibility

10. RESULTS Faculty Mean (out of 100) SD p Role model Peradeniya 68.01
Faculty
Mean
(out of 100) SD p
Role model
Peradeniya
68.01
14.37
0.01 
Kelaniya
63.87
15.04
Student experience
60.32
8.72
0.43 
61.15
9.50
Support for students
71.83
19.51
0.77 
72.47
17.24

11. Results Highly rated items by both groups
Consultants communicate concern and interest in patients as unique persons
Intern house officers develop good rapport with patients
Consultants take seriously patients’ concerns about their conditions or care
Intern house officers take seriously patients’ concerns about their conditions or care
Registrars / senior house officers develop good rapport with patients
Registrars / senior house officers take seriously patients’ concerns about their conditions or care

12. Results Poorly rated items by both groups
You have to convey bad news to a patient without any teaching or discussion about how to break the news in a caring manner.
A SHO, Registrar or intern house officer observes you while you interview a patient and provides you with feedback on your bedside manner.
You are asked to interview a patient and you are provided with feedback on how well you listened to the patient. (Either from the patient or an observer).
You and your ward team have to convey bad news to a patient. Sometime after the bad news is conveyed, you find yourself having to answer many of the patient’s questions about the news without any teaching.

13. Conclusions The tool appears measure what it purports to measure.
Although the institutional culture is somewhat conducive for patient- centred practice there is room for improvement.
‘Role models’ appear to advise on patient-centred practice.
The demonstration of patient-centred behaviours by ‘role models’ may need to be improved

14. references
ABIM Foundation (2002). Medical Professionalism in the New Millennium: A Physician Charter. Annals of Internal Medicine, 136(3):243. Borgstrom, E., S. Cohn, et al. (2010). Medical professionalism: conflicting values for tomorrow's doctors. Journal of General Internal Medicine 25(12): GMC (2009). Tomorrow's doctors. London General Medical Council Haidet et al 2005 Characterizing the Patient-Centeredness of Hidden Curricula in Medical Schools: development and Validation of a New Measure. Academic Medicine; 80:44–50. Hofstede, G., G. J. Hofstede, et al. (2010). Culture and organisations; software of the mind. New York, McGraw Hill. Stewart M. What is a successful doctor-patient interview? A study of interactions and outcomes. Social Sciences in Medicine. 1984;19:167–75.

15. What are your questions?
Thank you
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