Interrogating patient-centredness in undergraduate medical education using an integrated behaviour model

Abstract

Background: Patient-centredness, an approach that puts the patient at the centre of the consultation, thus focusing on patients instead of on his/her diseases, has been identified by most medical schools as a desired core competence of their graduates. Despite some curriculum initiatives, medical students often display a lack of patient-centredness upon graduation. This bears reason for concern and it was thus deemed important to explore possible factors that influence the teaching and learning of patient-centredness in an undergraduate medical curriculum. The article suggests a framework that can assist programme developers to conceptualise the teaching and learning of patient-centredness across an undergraduate curriculum. Methods: A qualitative exploratory case study design was used for the study with final-year medical students. Themes of meaning were deduced from the data by employing components of an Integrated Behavior Model (IBM) of Fishbein. Results: The findings of the study revealed that seven factors play a role: background characteristics of students, attitudinal factors, subjective norms (the hidden curriculum), student self-efficacy, acquired skills and knowledge, the environment or context within which patient-centredness is taught and learnt, as well as assessment of learning. Conclusions: Patient-centredness is a complex construct and authors often write about only one of its components. This paper attempts to consider the total undergraduate medical curriculum students are exposed to when they learn about being patientcentred. The teaching and learning of such a multidimensional construct require a comprehensive approach in order to be effective and the IBM seems to be a useful and applicable theoretical model to apply.

Inclusion of person-centred care in UK postgraduate medical education curricula: Interviews and documentary analysis

“…These factors make assessment of PCC competence amongst trainees, and the success of the curricula in helping trainees to achieve that competence, challenging. Without adequate quality assurance, PCC skills are unlikely to be held to the same rigour as other areas of the curriculum [ 66 ]. While greater involvement of Royal Colleges could ensure greater consistency in approaches across local deaneries, there is value in flexibility of local provision to meet local needs, and it is important to strike a balance between the two.…”

The Training of Undergraduate Medical Students in General Medical Practice and Primary Health Care: A Scoping Review

“…There were various views and perceptions among the trainer stakeholders regarding the training in general practice, which became an important element to consider as it played a role in the training process [15,95,106,128,149]. GPs regarded the training of students in their practices as an opportunity for continuous self-learning and an enhancement of their self-esteem [95].…”

“…However, this was counterbalanced by the fact that the GPs involved tended to engage in continuous professional development, in order "to rise to the occasion" [95]. Patients were positive about their involvement in student learning [106,128]. They were gratified by the contribution they were making in the training of future medical practitioners [114].…”

“…Every consultation has to display patient-centredness, which is an approach that puts the patient rather than their disease into focus, with holistic care [126,127]. This approach has been identified as one of the core required competencies [128,129]. In demonstrating patient-centredness, the students were trained to follow the patient's agenda, adopt a comprehensive (bio-psycho-social) approach and be empathetic to the patient.…”

Medical students’ attitudes towards patient-centered care, Fayoum Medical School, Egypt

“…Patient-centered care not only builds caring and compassion between healthcare providers and patients, but also reduces the cost of medical care and creates a positive sustainable healthcare experience [6,7]. Hence, it improves patient satisfaction, patients' quality of life and reduces anxiety associated with the health state or accessing healthcare facilities [8].…”