CLINICAL TEACHERS AS HUMANISTIC CAREGIVERS AND EDUCATORS - PERCEPTIONS OF SENIOR CLERKS AND 2ND-YEAR RESIDENTS

Background: The acquisition and nurturing of humanistic skills and att itudes constitute an important aim of medical education. In order to a ssess how conductive the physician-learning environment is to the acqu isition of these skills, the authors determined the extent to which cl inical teachers are perceived by their trainees, as humanistic with pa tients and students, and they explored whether undergraduate and gradu ate students share the same perceptions. Methods: A mail survey was co nducted in 1994/95 of all senior clerks and second-year residents at L aval University, University of Montreal and University of Sherbrooke m edical schools. Of 774 trainees, 259 senior clerks and 238 second-year residents returned the questionnaire, for an overall response rate of 64%. Students' perceptions of their teachers were measured on a 6-poi nt Likert scale applied to statements about teachers' attitudes toward the patient (5 items) and toward the student (5 items). Results: On a verage, only 46% of the senior clerks agreed that their teachers displ ayed the humanistic characteristics of interest. They were especially critical of their teachers' apparent lack of sensitivity, with as many as 3 out of 4 declaring that their teachers seemed to be unconcerned about how patients adapt psychologically to their illnesses (75% of cl erks) and that their teachers did not try to understand students' diff iculties (78%) or to support students who have difficulties (77%). Com pared with the clerks, the second-year residents were significantly le ss critical, those with negative perceptions varying from 27% to 58%, 40% on average. Except for this difference, their pattern of responses from one item to another was similar. Interpretation: This study sugg ests the existence of a substantial gap between what medical trainees are expected to learn and what they actually experience over the cours e of their training. Because such a gap could represent a significant barrier to the acquisition of important skills, more and urgent resear ch is needed to understand better the factors influencing students' pe rceptions.