Date of Award


Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Education


Center for the Advancement of Education


The purpose of this study was to develop a role for the patient perception of care provided by the student doctor within the educational program at Palmer College. The Council on Chiropractic Education, the federally recognized accrediting body of the profession, has indicated that the perception of care by the patient receiving that care should be an important outcome measure of the education process in the colleges. At the time of this study the patient's perception of care was not used in evaluating clinical competence. A review of the literature resulted in the selection of the Patient-Doctor Interaction Scale (PDIS) to measure selected elements of patient perceptions related to patient satisfaction. It was hypothesized that there would be a relation between the length of student doctor training and patient satisfaction. The relation might include academic variables of grade point average, number of clinic courses completed, and grades in specific courses or groups of courses. The instrument was used to sample patient encounters at the Palmer College Chiropractic Clinic, and compared statistically to academic indicators. The student sample used those eligible for clinic extern status. Statistical procedures including a Wilks-Lambda discriminant analysis were used to investigate relationships and to predict which students’ care would satisfy the patient. Overall, the level of satisfaction was higher than that reported in the use of the scale by family practice clinics. Results indicated that the number of courses completed by the extern was not a significant factor for patient satisfaction, but there was a correlation with grade point average for each group. It was possible to correctly classify 71.6% of the students according to high and low levels of patient satisfaction, using grades achieved in all previous course work and to correctly classify 62.9% of the students if only the first-year courses were used. Grades received in departments were less reliable than the overall grade point average. Two shorter versions of the PDIS were constructed and compared favorably with the original instrument. If shown to be reliable, these would enhance the utility and the speed of assessment in the clinical setting. The results helped to define affective components for the education of clinical externs. The information became useful for (1) identifying students who may need help in patient management, (2) revising the instruction of the students in basic patient protocols, (3) performing physical examinations and treatment, and (4) modifying student information about psychological aspects of patient care. It also satisfied a concern that patient satisfaction would be used as an outcome measure of education, and added to the stature of the course grades. Recommendations were made through the Clinic Committee that sampling patient satisfaction be continued at least once per term, if not for all encounters; that further analysis be done to compare patient satisfaction and student scores on Qualitative Evaluations of care; and that the predictive course grades be used by Student Affairs counselors to work on an individual basis with students. If the scales were to be used with all patient encounters, feedback to the individual student about different aspects of the variable would be possible.

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