Patient-centred care during medical internship: a longitudinal study of humanisation of care in undergraduate medical education

Patient-centred care is a fundamental competency in contemporary medical education and a key determinant of the quality and safety of healthcare. Longitudinal evidence suggests that patient-centred attitudes may change during the clinical rotation period, particularly during internship, when students are exposed to increased workload and different learning environments. This study aimed to assess longitudinal changes in patient-centred orientation among medical interns and to investigate associations with quality-of-life indicators, specialty choice, and perceptions of the educational environment. A longitudinal study was conducted among fifth-year medical students during their clinical rotation at a Brazilian public university (n = 83). Data collection took place between 30 April 2021 and 16 August 2022. The Patient–Practitioner Orientation Scale (PPOS) was administered on three occasions over the two-year internship period. The first data collection occurred at the beginning of the internship, the second at the end of the fifth year, and the third at the end of the sixth year. Sociodemographic characteristics were collected during the first data collection. Variables related to specialty choice and quality of life included satisfaction with leisure activities, social support, physical activity, sleep quality, difficulty sleeping, and financial satisfaction. From the second data collection onwards, perceptions regarding the educational environment were also assessed. Mean PPOS scores were compared using the Wilcoxon and Kruskal–Wallis tests, adopting a significance level of p < 0.05. Differences by sex were observed in the first (p = 0.005) and third (p = 0.032) data collection rounds, with higher mean PPOS scores among male students. No associations were found between PPOS scores and quality-of-life indicators in any of the three data collections. In the third assessment, students who reported never feeling pressured by patient demand had higher PPOS scores (p = 0.031). Regarding specialty choice, interns opting for surgical fields (2.44 ± 0.46) and those opting for more than one specialty (2.44 ± 0.45) showed the highest mean PPOS scores, although without statistical significance (p = 0.552). Longitudinal comparison between the first and third assessments showed that students whose PPOS scores decreased over time had higher baseline scores (p = 0.011), while those who maintained or increased their scores presented higher final PPOS values (p = 0.005). In the multivariate analysis, female sex was associated with a lower likelihood of maintaining or increasing PPOS scores over time (OR = 0.75), while no independent associations were observed for quality-of-life variables or educational climate indicators. Patient-centred orientation changed throughout the clinical rotation. Quality-of-life indicators were not independently associated with PPOS scores. Perceived workload pressure, a component of the educational climate, was associated with patient-centred orientation in the final assessment, suggesting that structural aspects of clinical training may influence the development of patient-centred attitudes. Students who chose surgical specialties and those considering more than one specialty showed higher patient-centred scores, which may reflect group heterogeneity by sex and an increased need for communication skills, as well as the growing role of shared decision-making in surgical settings. Overall, the findings reinforce the central role of the educational environment in shaping patient-centred orientation during medical internship.