Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study
Medical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice ‘teaching microsystem’ and participate in patient care as part of this community of practice (CoP). This study evaluates patients’ perceptions of the clerkship initiative, and their perspectives on this approach to training ‘much-needed’ doctors in their community.
Semi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes.
The twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as ‘becoming’. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care.
Regional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice ‘teaching microsystem’ allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.
- Hudson JN, Weston KM, Farmer EA, Ivers RG, Pearson RW: Are patients willing participants in the new wave of community-based medical education in regional and rural Australia? MJ A 2010, 192:150-153.
- Prystowsky JB, Bordage G: An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction. Med Educ 2001, 35:331-336. CrossRef
- Oswald N, Alderson T, Jones S: Evaluating primary care as a base for medical education: The report of the Cambridge community based clinical course. Med Educ 2001, 35:782-788. CrossRef
- Worley P, Silagy C, Prideaux D, Newble D, Jones A: The parallel rural community curriculum: An integrated clinical curriculum based in rural general practice. Med Educ 2000, 34:558-565. CrossRef
- Walters LK, Worley PS, Mugford BV: Parallel Rural Community Curriculum: is it a transferrable model? Rural Remote Health 2003, 3:236.
- Thistlethwaite JT, Kidd MR, Hudson JN: Will general practice become the leading provider of medical student education in the 21st century? MJA 2007, 187:124-128.
- Regan-Smith M, Young WW, Keller AM: An Efficient and Effective Teaching Model for Ambulatory Education. Acad Med 2002, 77:593-599. CrossRef
- Worley P, Prideaux D, Strasser R, MaGarey A, March R: Empirical evidence for symbiotic medical education: a comparative analysis of community and tertiary-based programmes. Med Educ 2006, 40:109-116. CrossRef
- Nelson EC, Batalden PB, Godfrey MM: Quality by design: A clinical micro-systems approach. Jossy-Bass, San Francisco, CA; 2007.
- Worley P, Kitto P: A hypothetical model of the financial impact of student attachments on rural general practices. Rural Remote Health 2001, 1:83.
- Hudson JN, Weston KM, Farmer EA: Medical students on long-term placements: what is the financial cost to supervisors? Rural Remote Health 2012, 12:1951.
- Lave J, Wenger E: Situated learning: Legitimate peripheral participation. Cambridge University Press, Cambridge; 1991. CrossRef
- Wenger E: Communities of Practice: Learning, meaning and identity. Cambridge University Press, Cambridge; 1998.
- Hudson JN, Weston KM, Farmer EA: Why do rural GPs engage in longitudinal integrated community-based clerkships at a time of workforce shortage? BMC Fam Pract 2011, 12:103. CrossRef
- Hirsh DA, Ogur B, Thibault GE, Cox M: New models of clinical clerkships: “Continuity” as an organizing principle for clinical education reform. N Engl J Med 2007, 356:858-866. CrossRef
- Wykurz G, Kelly D: Developing the role of patients as teachers: literature review. BMJ 2002, 325:818-821. CrossRef
- Haffling A-C, Hakansson A: Patients consulting with students in general practice: survey of patients’ satisfaction and their role in teaching. Med Teach 2008, 30:622-629. CrossRef
- Graneheim UH, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today 2004, 24:105-112. CrossRef
- Searl MM, Borgi L, Chemali Z: It is time to talk about people: a human-centred healthcare system. Health Res Policy Syst 2010, 8:35. CrossRef
- Plochg T, Klazinga NS, Starfield B: Transforming medical professionalism to fit changing health needs. BMC Med 2009, 7:64. CrossRef
- Sturmberg JM, O’Halloran DM, Martin CM: Understanding health system reform—a complex adaptive systems perspective. J Eval Clin Pract 2012, 18:203-208.
- Monrouxe LV: Identity, identification and medical education: why should we care? Med Educ 2010, 44:40-49. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/13/72/prepub
- Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Family Practice
- Online Date
- July 2012
- Online ISSN
- BioMed Central
- Additional Links
- Rural medical education
- Longitudinal integrated clerkships
- Patients as stakeholders