A Dialogic Approach to Teaching Person-Centered Care in Graduate Medical Education

Abstract

Background Training future physicians to provide compassionate, equitable, person-centered care remains a challenge for medical educators. Dialogues offer an opportunity to extend person-centered education into clinical care. In contrast to discussions, dialogues encourage the sharing of authority, expertise, and perspectives to promote new ways of understanding oneself and the world. The best methods for implementing dialogic teaching in graduate medical education have not been identified. Objective We developed and implemented a co-constructed faculty development program to promote dialogic teaching and learning in graduate medical education. Methods Beginning in April 2017, we co-constructed, with a pilot working group (PWG) of physician teachers, ways to prepare for and implement dialogic teaching in clinical settings. We kept detailed implementation notes and interviewed PWG members. Data were iteratively co-analyzed using a qualitative description approach within a constructivist paradigm. Ongoing analysis informed iterative changes to the faculty development program and dialogic education model. Patient and learner advisers provided practical guidance. Results The concepts and practice of dialogic teaching resonated with PWG members. However, they indicated that dialogic teaching was easier to learn about than to implement, citing insufficient time, lack of space, and other structural issues as barriers. Patient and learner advisers provided insights that deepened design, implementation, and eventual evaluation of the education model by sharing experiences related to person-centered care. Conclusions While PWG members found that the faculty development program supported the implementation of dialogic teaching, successfully enabling this approach requires expertise, willingness, and support to teach knowledge and skills not traditionally included in medical curricula.

Rodas de conversa remotas: ensino-aprendizagem e vivência da promoção da saúde na pandemia da Covid-19

“…O profissional médico, ao completar sua formação, deve ser capaz de atuar nos diferentes níveis de atenção à saúde, o que compreende o espectro da diversidade humana, a integralidade do cuidado, a promoção da saúde, o cuidado centrado na pessoa, as habilidades de comunicação, o trabalho em equipe, a tomada de decisões e a liderança 1 . Somado a isso, é ainda um desafio para os docentes ensinar aos futuros médicos mecanismos para exercer essas práticas 25 . Assim, considerando as dimensões técnicas, humanísticas e éticas que a graduação em Medicina deve proporcionar, é essencial que metodologias de ensino focadas no desenvolvimento dessas competências sejam aplicadas no ensino médico.…”

Optimising planned medical education strategies to develop learners' person‐centredness: A realist review

“…She has called for education that supports the emotional work and critical reflection needed to develop self‐awareness to be the foundation for medical educational curricular reform. More recently, incorporation of dialogic learning into medical education has been proposed to enhance person‐centred practice 118 . Dialogic learning involves regular opportunities for teachers and learners to meet in non‐hierarchical settings to reflect on patient experiences.…”

“…More recently, incorporation of dialogic learning into medical education has been proposed to enhance person‐centred practice. 118 Dialogic learning involves regular opportunities for teachers and learners to meet in non‐hierarchical settings to reflect on patient experiences. In the wider health care context, Schwartz rounds, which provide multidisciplinary teams the opportunity to process their emotional and cognitive responses to clinical practice, have been shown to support person‐centred attitudes.…”

Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond

“…Although faculty development for dialogical teaching in healthcare education is effective, implementation may be limited by time and space structural barriers. 65 Dialogical moments may be introduced in the moment of acknowledging suffering or distress, and introducing reflective questions or outlining moral dilemmas to stimulate curiosity and further exchange. A formal system in which CoPs are established for trainees and led by trained facilitators would create a space in which to build collective moral resilience.…”