Patient-centered care and interprofessional collaboration in medical resident education: Where we stand and where we need to go

Abstract

Patient centered care (PCC) and interprofessional collaboration (IPC) remain important goals for all healthcare systems. While these tenets are a cornerstone of training for nursing and allied health professionals (AHPs), their role in internal medicine resident (IMR) training is unstructured and limited. We performed a narrative review to answer two questions, firstly ‘what is known about the attitudes and behaviors of internal medicine (IM) physicians and trainees with respect to PCC and IPC and how does this compare to AHPs?’ and secondly, ‘what evidence based interventions have been trialed to promote PCC and IPC in medical training?’ We searched databases including Cochrane, Medline, Embase, CINAHL and MedPortal. We reviewed 102 publications and found that medical residents tend to value PCC less than non-physician trainees. Hierarchical professional attitudes and a poor understanding of AHP roles are barriers to IPC, whereas diminished time for direct patient care, neglect of the patient’s context and social determinants of health, and lack of self-reflection are barriers to PCC. Published educational interventions for IMRs and AHPs have included classroom sessions, structured ward- and clinic-based interprofessional (IP) work, post-discharge care, home visits, and reflective practice. Interventions were evaluated using questionnaires/surveys, focus groups, tests, primary outcome assessments and ethnographic analysis. The most promising interventions are those that allow learners time for multidisciplinary observation, holistic patient assessments, engagement in care transitions and reflective practice. Based on the review findings we have made recommendations for integration of IPC and PCC training into IMR curricula. Future educational interventions should allow IMR observerships in a multidisciplinary team, introduce residents to the patient’s environment through home visits, incorporate patient/family perspectives in care, and include narrative reflections as part of professional development. Based on our findings and recommendations, these experiences can provide IMRs with much-needed exposure to collaborative, patient-centric care early in postgraduate training.

The development of an instrument to measure interprofessional collaboration competency for primary care teams in the district health system of health region 2, Thailand

“…The dimensions of population-and community-centred care were similar to those in previous studies [11,19,20]. According to the health care transition towards patient-centred, community-based care and home care, it is becoming increasingly important to train health care providers to achieve competency in the arena of patientcentred care [10]. Moreover, Thailand provides primary care through DHSs, such as community health funds, long-term care funds with home health care services at the patient's home, and noncommunicable disease prevention and control [13,55,56].…”

“…According to the concept of IPC defined by the World Health Organization (WHO), which involves all sectors' engagement in health and emphasizes patient-centred care [10], differences in the context of the implementation of IPC in hospitals, primary care facilities, and educational institutions are influenced by various factors, including sociocultural characteristics within an institution or within each group of health profession teams [11]. In Thailand, primary care services provided through a network that called district health system (DHS), provide health promotion, disease surveillance, home healthcare, out-patient services with supervision and support by medical doctors and health care provider from district hospitals for Thai citizen under universal health coverage.…”

Assessing interprofessional and integrated care in providing sexual and reproductive health services to adolescents at primary healthcare level in Nigeria

“…Studies have argued that the presence of interprofessional care in any health facility is an important measure to assess resilience, which can be defined by public trust and confidence in the facility, and its response to crisis (Gantayet-Mathur et al, 2022;Tsakitzidis et al, 2017;Weiss et al, 2014). Uzochukwu et al (2023), posited that lack of interprofessional care in health facilities exacerbates healthcare complexities and puts service users at risk.…”

The Patient Experience of Adolescents With Traumatic Injuries: Recommendations for Improvement

“…In the United States, patient-centered care (PCC) is one of six fundamental aims of the healthcare system (Engle et al, 2019; Epstein & Street, 2011). To design and manage care that is respectful of and responsive to the preferences, values, and needs of individual patients, PCC requires active collaboration and shared decision-making between patients and providers (Epstein & Street, 2011; Institute of Medicine Committee on Healthcare in America, 2001; Gantayet-Mathur et al, 2022). Frequently measured through patient experience, PCC provides unique patient insights into the quality of care provided (Berwick et al, 2008; Epstein & Street, 2011; Santana et al, 2020).…”