The Feasibility of Longitudinal Patient Contacts in a Large Medical School

Abstract

Problem: Longitudinal patient contacts are being implemented worldwide as a way to enhance a patient-centered orientation among medical students. In large medical schools, longitudinal integrated clerkships may not be feasible, so other ways must be sought to expose students to prolonged contact with patients. Intervention: Medical students were attached to a family practice and assigned a panel of 4 patients to follow over the 3 years of their clinical training. Their role was that of companion on the patient's medical journey. The program consisted of several encounters, joining the patient in the medical setting for significant events, and written assignments. This intervention was piloted with 35 students. We describe our experiences from the 1st pilot year of this program. Context: The intervention was performed with 3rd-year students-of a 6-year curriculum-at a large medical school in the Netherlands. Outcome: Finding enough patients per practice was feasible. On the whole, students fulfilled the program's expectations regarding frequency of patient encounters and assignments. The most frequent problems encountered by the students were uncertainty about their role and setting boundaries in their contact with the patients. They needed more preceptor supervision and coaching than they received. Lessons Learned: For junior students, close and structured supervision led by the faculty is necessary to help them navigate and learn from a panel of patients. Students need guidance about what role they should take on and on how to manage both their own and their patient's expectations. Guided reflection is necessary to help students give meaning to their experiences with patients.

A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application

“…Students undertaking an LIC can experience stress and uncertainty when faced by, what can first appear as, unpredictable clinical opportunities and engagement simultaneously in multiple disciplines. 26,67,68 Students may be faced with logistical difficulties in organising and gaining access to secondary care services and, due to the length of waiting times for non-urgent NHS care, students may be unable to follow the same patient's journey through to secondary care, 21 giving rise to further uncertainty. Given this, learner disorientation within LICs is relatively common and may give rise to student anxiety.…”

Learning from patients about patient-centredness: A realist review: BEME Guide No. 60

“…We conducted an initial scope of the literature which helped us to identify which definitions for patientcentredness were used and the different intervention-types described that aim for developing patient-centredness in participants. We discussed the outcomes of this scoping of the literature within the team, in which one author has written her doctoral thesis on patient-centredness in medical students (KB), another author on learning from preclinical patient contacts (AD), and two others (SM, DZ) were involved in a patient panel intervention within a Dutch medical curriculum (Mol et al 2019). During these discussions, a major discussion point was whether we should limit our search to patient panels only (where we expected the yield to be minimal) or a broad range of interventions without limitation up-front.…”

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

“…This study focusses on an adjusted form of a LIC program, which was introduced in the UMC Utrecht in 2015. In this educational program called the patient panel program, students followed patients in an out-of-hospital setting for two years [22]. The aim was to promote patientcentredness in students during their clinical development.…”