Do students learn to be more conscientious at medical school?

BACKGROUND: Professionalism in medical students is not only difficult to define but difficult to teach and measure. As negative behaviour in medical students is associated with post-graduate disciplinary action it would be useful to have a model whereby unprofessional behaviour at the undergraduate level can easily be identified to permit appropriate intervention. We have previously developed a scalar measure of conscientiousness, the Conscientiousness Index (CI), which positively correlates to estimates of professional behaviour in undergraduate medical students. By comparing CI points awarded in year 1 and year 2 of study we were able to use the CI model to determine whether teaching and clinical exposure had any effect on students' conscientiousness. METHODS: CI points were collected by administrative staff from 3 successive cohorts of students in years 1 and 2 of study. Points were awarded to students for activities such as submission of immunisation status and criminal record checks, submission of summative assignments by a specified date and attendance at compulsory teaching sessions. CI points were then converted to a percentage of maximal possible scores (CI %) to permit direct comparison between years 1 and 2 of study. RESULTS: CI % scores were generally high with each year of study for each cohort showing negatively skewed normal distributions with peaks > 89%. There was a high degree of correlation of CI % scores between year 1 and year 2 of study for each cohort alone and when cohort data was combined. When the change in CI % from year 1 to year 2 for all students was compared there was no significant difference in conscientiousness observed. CONCLUSIONS: We have provided evidence that use of a CI model in undergraduate medical students provides a reliable measure of conscientiousness that is easy to implement. Importantly this study shows that measurement of conscientiousness by the CI model in medical students does not change between years 1 and 2 study suggesting that it is a stable characteristic and not modified by teaching and clinical exposure.

Patients and their families weigh in on evidence-based hospital design.

BACKGROUND: In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006. OBJECTIVE: To determine perceptions of patients and their families of evidence-based design features in a new heart center. METHODS: Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients' satisfaction with the environment. Results Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed. CONCLUSIONS: Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients' safety, satisfaction, and quality of care.