Fostering patient-centredness by following patients outside the clinical setting: an interview study

Abstract

Background: Patient-centredness is considered a core competency for health professionals. To support faculty in designing courses focused on patient-centredness, an understanding of how educational interventions lead to patient-centredness is required. This study aims to show how learning mechanisms, which potentially contribute to patient-centredness, are triggered. Methods: Thirty-five third-year medical students at the UMC Utrecht followed four different patients for two years. The intervention took place in an out-of-hospital setting. Students visited patients in their home circumstances and accompanied them to clinical events. Twelve students were interviewed. The realist approach was used to construct configurations which relate components of the intervention to the context and learning mechanisms. Results: Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. In the context of a meaningful relationship and continuity, mechanisms contributing to learning patient-centredness were triggered. The most important learning mechanisms found in this study were: reflecting, contextualising disease in a real persons' life, broadening perspectives and engaging with the patients. Conclusions: Learning mechanisms are triggered by continuity and by meaningful student-patient relationships. These can be enhanced by an out-of-hospital setting and longitudinal contact. Thus, a relationship between students and patients is an important enabler for the development of patient-centredness.

Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa

“…There was no patient-centeredness as described in literature observed in any of the 5 consultations. 36 , 37 , 38 Unlike the other consultations, Doctor 9 (Consultation 2) partially succeeded in involving the patient in the conversation but did not demonstrate other aspects of patient-centeredness. Unfortunately, all the consultations had evidence of paternalism and a lack of partnership.…”

Candid insights and overlooked facets: what medical students write about patient-centeredness in diaries on longitudinal patient contacts

“…These relationships, we believe, served as a catalyst for the students’ deeper reflections. Moreover, ongoing engagement with patients in medical education nurtures a patient-centered identity, ideally early in the studies, so that it becomes an inherent and expected aspect of a student’s professional attitude [ 35 , 36 ]. Therefore, students should be offered longitudinal interventions with real patients in the early stages of medical education to ensure that patient-centeredness becomes an integral part of their future identity and practice, aligning with the evolving expectations and demands of modern healthcare.…”

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked

“…Research suggests that a biopsychosocial and culturally sensitive approach, that is characteristic of a holistic practice, can contribute to sexual history taking. 39 , 40 , 41 Good communication is required to facilitate holistic practice, whereas doctors displayed reasonable communication skills in only 12% of the consultations. One understands that sexual functioning is a sensitive matter, and that it might elicit discomfort if the doctor does not know how to start the conversation.…”