Alliance, Trust, and Loss: Experiences of Patients Cared for by Students in a Longitudinal Integrated Clerkship

Abstract

Interview protocol (English) Over the past year, we understand Medical Student X was involved in your care here with your primary care doctor, Dr. X, and may have seen you in other clinics or in the hospital as well. We know that you've had a long-standing and separate relationship with your primary care doctor, but we are specifically interested in how a student might add or take away from that relationship with your doctor. Can you tell me about a time working with student name during the last year? (quality of care) Prompts if needed: Was there one example of a time that was particularly meaningful or had a big impact on you? Can you describe situations when the student positively affected your care?... negatively affected your care? In what ways was it helpful to have student there; it what ways was it more difficult? How was your care different when student name was there? (patient experience) Prompts if needed: examples might include communication between doctors in different areas, time require or allowed for your visits, follow up information provided, education about your condition, time to address your concerns, feeling comfortable during the visit, feeling respected during the visit. Were you more or less satisfied having student involved in your care? Why? (satisfaction) Looking after your health is complex and involves a lot of decisions and appointments to see your doctor. Was managing your health care easier or harder with student involved? (engagement) The Denver Health system is very complex and patients often struggle with things like finding appointments, scheduling appointments, knowing which doctors to call with questions. Was student able to help you get the right kind of care when you needed it? (system navigation) Prompts if needed: Tell us about a time that happened Many patients find all of the information about health problems, medications, doctors, etc. to be really confusing. Do you think having student involved helped you understand your health and medical problems? (health literacy) If yes: How did that change your decisions about your health care? Prompts if needed: Tell us about a time that was the case. In what ways did student help you learn to take better care of your health? (self efficacy) Prompt if needed: can you describe a time when the student did this? We know that factors outside of the clinic have important impacts on your health. Things like the cost of medications, having a safe place to stay, being able to afford healthy foods, having child care and

Social Identification with the Medical Profession in the Transition from Student to Practitioner

“…28 Other studies have shown how students from longitudinal integrated clerkships are seen by patients as critical member of their care team. 37 In our results, we found trainees were more likely to notice their value as doctors when they fulfill this role. They described, although in many cases implicitly, how this made them feel grateful and proud, enhancing their in-group experience.…”

Patient outcomes in a Longitudinal Integrated Clerkship: A systematic literature review

“…Twenty‐six studies were included 16,26,45–68 . LIC programmes at 16 institutions were described, representing six countries: Australia, Canada, South Africa, Taiwan, the United Kingdom and the United States.…”

“… Students bring efficiencies to consultations by completing histories and examinations for preceptors 50,67 Students bring thoroughness to consultations 49 and give attention and time to the patient 51,59,66 Students share patient information with healthcare professionals and across healthcare settings 45,49,51,59,64 Students support communication between healthcare professionals, 51,57,60 and healthcare settings 53 …”

“…independently performed a full paper review on 26 and 22 studies, respectively. Nineteen studies were included for thematic synthesis 16,26,45–61 …”

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

“…Longitudinal integrated clerkships (LICs) have been demonstrated to benefit students, [1][2][3] faculty, [4][5][6] patients, [7][8][9] communities, [10][11][12] and organizations, [13][14][15] yet understanding of why LICs work is limited. 16 Benefits include student engagement in advocacy, 17 preceptor satisfaction, 5 improved patient health, 7,18,19 and service provision. 13 A recent scoping review concluded LICs may confer benefits by facilitating student identity construction.…”