'Relationship-Centered Care' - Better Doctors Through Better Relationships

Main Category: Medical Students / Training
Also Included In: Primary Care / General Practice
Article Date: 16 Apr 2008 - 2:00 PDT

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Change can be difficult. It also can be rewarding. In the case of a medical school culture, change can have important consequences for what students learn and what type of physicians they ultimately become. Successfully altering an institution's culture can be accomplished without massive amounts of funding or strict administrative edicts, say researchers at the Indiana University School of Medicine.

A study published in an advanced online issue of the Journal of General Internal Medicine reports that dramatic change in the organizational culture of the nation's second largest medical school is being achieved through a process called relationship-centered care.

"Organizational culture is like the weather - everyone complains about it, but unlike the weather you can do something about it. We found that organizational culture at our medical school, and we believe at others, is subject to intentional change, so long as you use appropriate methods," said the study's senior author, Thomas Inui, M.D., associate dean for health services research at the IU School of Medicine and president and CEO of the Regenstrief Institute, Inc.

The momentum to change the organizational culture or informal curriculum of the IU School of Medicine began a decade earlier with the initiation of a curriculum expanded to include nine key competencies that IUSM medical students must achieve before graduation. These include clinical skills; self-awareness, self care and personal growth; professionalism and role recognition; social and community contexts of health care; and moral reasoning and ethical judgment.

"As we developed the competency curriculum, we realized that in addition to teaching these abilities, we needed to change the organizational and interpersonal environment of the school - the 'hidden curriculum' - so our school's informal curriculum and culture supported the values promoted by new curriculum. Unless we did this, we were sending a mixed message," said Ann Cottingham, M.A.R., director of special programs for the Office of Medical Education and Curricular Affairs and first author of the study.

At Indiana's only medical school, students, physicians in training (residents and fellows), faculty and staff are exposed to a relationship-centered learning environment which stresses, as Ms. Cottingham puts it, getting to know people as human beings, not just their professional roles.

To measure success, study authors looked at various measures including student satisfaction and application rates.

- Student satisfaction with the quality of their medical education increased with the initiation of relationship-centered care driven culture change and is higher than the national average. Prior to change in the organizational culture, this measure was consistently lower than the national average even though IUSM graduates consistently had scored above national averages on their professional licensing exams.

- Students rate responsiveness of administration to student problems higher than the national average. Prior to change in the organizational culture, this measure was consistently lower than the national average.

- There has been a sharp rise in number of out-of-state students applying to the school which, when added to an increase of in-state applicants, has led to a twofold increase in applications for admission.

- IU School of Medicine admissions officers seek students who, in addition to having outstanding academic credentials, are the kind of students who would be a good fit in an organization that values relationships as well as the comprehension of scientific principles and outstanding clinical skills.

The study concludes that "a culture-change initiative at one medical school succeeded in engaging many faculty and organization leaders within the school, stimulated a remarkable efflorescence of activities, enhanced its environment, and exerted a favorable impact on a variety of organizational performance indicators."

Funded in part by the Fetzer Institute, the study was co-authored by eight of the thousands of individuals who are participating in the culture change underway at the school.

http://www.iupui.edu