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      Informed consent learning: Needs and preferences in medical clerkship environments

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          Abstract

          Purpose

          Limited information exists regarding students’ routine educational needs in support of ethics and professionalism practices faced in real clinical practice. As such the authors aimed to explore medical students learning needs and preferences for informed consent and relevant ethical issues in the clerkship environments.

          Materials and methods

          A cross-sectional study using a self-administered, printed survey distributed to final year clinical clerks.

          Results

          84% completed the survey. Students indicated the need for more attention to all topics related to informed consent (mean = 7.1 on a scale of 0 to 9; ±1.2). Most additional instructional attention was requested for topics raised in discussions with patients concerning the risks, benefits and alternatives to recommended treatments (7.3 ±1.4). The cohort expressed the need for education in the care of vulnerable patients (7.2 ±1.2) with a maximum score for the care of abused children. Women perceived greater need for education concerning informed consent than male respondents ( p>0.05). There were significant differences between students who scored high or low on the item “being treated in professional manner” and “endorsement of educational needs for care of adolescents” ( p = 0.05).

          Conclusion

          There was heightened perception among final year medical students of the need for greater attention to be paid to informed consent education.

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          Most cited references31

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          Social constructivist perspectives on teaching and learning.

          Social constructivist perspectives focus on the interdependence of social and individual processes in the co-construction of knowledge. After the impetus for understanding the influence of social and cultural factors on cognition is reviewed, mechanisms hypothesized to account for learning from this perspective are identified, drawing from Piagetian and Vygotskian accounts. The empirical research reviewed illustrates (a) the application of institutional analyses to investigate schooling as a cultural process, (b) the application of interpersonal analyses to examine how interactions promote cognition and learning, and (c) discursive analyses examining and manipulating the patterns and opportunities in instructional conversation. The review concludes with a discussion of the application of this perspective to selected contemporary issues, including: acquiring expertise across domains, assessment, educational equity, and educational reform.
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            Medical student attitudes toward the doctor-patient relationship.

            Medical educators have emphasized the importance of teaching patient-centred care. To describe and quantify the attitudes of medical students towards patient-centred care and to examine: (a) the differences in these attitudes between students in early and later years of medical school; and (b) factors associated with patient-centred attitudes. We surveyed 673 students in the first, third, and fourth years of medical school. Our survey utilized the Patient-Practitioner Orientation Scale (PPOS), a validated instrument designed to measure individual preferences towards various aspects of the doctor-patient relationship. Total PPOS scores can range from patient-centred (egalitarian, whole person oriented) to disease- or doctor-centred (paternalistic, less attuned to psychosocial issues). Additional demographic data including gender, age, ethnicity, undergraduate coursework, family medical background and specialty choice were collected from the fourth year class. A total of 510 students (76%) completed data collection. Female gender (P < 0.001) and earlier year of medical school (P = 0.03) were significantly associated with patient-centred attitudes. Among fourth year students (n = 89), characteristics associated with more patient-centred attitudes included female gender, European-American ethnicity, and primary-care career choice (P < 0.05 for each comparison). Despite emphasis on the need for curricula that foster patient-centred attitudes among medical students, our data suggest that students in later years of medical school have attitudes that are more doctor-centred or paternalistic compared to students in earlier years. Given the emphasis placed on patient satisfaction and patient-centred care in the current medical environment, our results warrant further research and dialogue to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centred care.
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              Informed consent for clinical treatment.

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 October 2018
                2018
                : 13
                : 10
                : e0202466
                Affiliations
                [1 ] Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
                [2 ] Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
                [3 ] Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
                [4 ] Department of Medical Education, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
                Public Library of Science, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0263-5168
                Article
                PONE-D-17-16953
                10.1371/journal.pone.0202466
                6169846
                30281603
                23658603-e365-4a5e-b343-5a4024f0f08a
                © 2018 AlMahmoud et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 May 2017
                : 3 August 2018
                Page count
                Figures: 0, Tables: 3, Pages: 12
                Funding
                The authors received no specific funding for this work.
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