Advertisement

Advances in Health Sciences Education

, Volume 13, Issue 1, pp 89–107 | Cite as

Students Learning from Patients: Let’s Get Real in Medical Education

  • Alan BleakleyEmail author
  • John Bligh
Article

Abstract

Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient’s care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad ‚professionalism’ framework. Paradoxically, while aiming to strengthen patient–student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical ‚education’ displaces traditional forms of medical ‚training’ that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.

Keywords

communication history of medical education identity construction patient-centred education role modelling text 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Baron R. (1990). Medical Hermeneutics: Where is the ‘Text’ We Are Interpreting? Theoretical Medicine 11: 25–28CrossRefGoogle Scholar
  2. Bleakley A. (2002). Pre-registration house officers and ward-based learning: a ‘new apprenticeship’ model. Medical Education 36: 9–15CrossRefGoogle Scholar
  3. Bleakley A. (2006). Broadening conceptions of learning in medical education: the message from teamworking. Medical Education 40: 150–157CrossRefGoogle Scholar
  4. Bleakley A., Farrow R., Gould D., Marshall R. (2003). Making sense of clinical reasoning: judgement and the evidence of the senses. Medical Education 37: 544–552CrossRefGoogle Scholar
  5. Bleakley A., Boyden J., Hobbs A., Walsh L. (2004). Safety in operating theatres: Improving teamwork through team resource management. Journal of Workplace Learning 16: 83–91CrossRefGoogle Scholar
  6. Branch W.T. (2006). Teaching respect for patients. Academic Medicine 81: 463–467CrossRefGoogle Scholar
  7. Daniel S. (1986). The patient as text: a model of clinical hermeneutics. Theoretical Medicine 7: 195–210CrossRefGoogle Scholar
  8. De Certeau M. (1984). The Practice of Everyday Life. Berkeley: University of California PressGoogle Scholar
  9. De Valck C., Bensing J., Bruynooghe R., Batenburg V. (2001). Cure-oriented versus care-oriented attitudes in medicine. Patient Education and Counselling 45(2): 119–121CrossRefGoogle Scholar
  10. Dogra N., Karnik N. (2003). First-year medical students’ attitudes toward diversity and its teaching: an investigation at one U.S. Medical School. Academic Medicine 78: 1191–1200CrossRefGoogle Scholar
  11. Engestrom Y. (2004). New forms of learning in co-configuration work. Journal of Workplace Learning 16: 11–21CrossRefGoogle Scholar
  12. Engestrom, Y. (2006). Collaborative intentionality capital: object-oriented interagency in multiorganizational fields. <http://www.edu.helsinki.fi/activity/people/engestro/>Google Scholar
  13. Foucault M. (1972). The Archaeology of Knowledge. London: Tavistock PublicationsGoogle Scholar
  14. Fulford K.W.M., Ersser S., Hope T. (1995). Essential Practice in Patient-centred Care. Oxford: Blackwell ScienceGoogle Scholar
  15. Haidet P., Dains J.E., Paterniti D.A., Hechtel L., Chang T., Tseng E., Rogers J.C. (2002). Medical student attitudes toward the doctor-patient relationship. Medical Education 36: 568–574CrossRefGoogle Scholar
  16. Haidet P., Kelly P.A., Chou C.: Communication, Curriculum, Culture Study Group. (2005). Characterizing the patient-centeredness of hidden curricula in medical schools: development and validation of a new measure. Academic Medicine 80: 44–50CrossRefGoogle Scholar
  17. Hopkins P. (Eds) (1972). Patient Centred Medicine. London: Regional Doctor PublicationsGoogle Scholar
  18. Howe A. (2001). Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education. Medical Education 35: 666–672CrossRefGoogle Scholar
  19. Hunter K-M. (1993). Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University PressGoogle Scholar
  20. Inui T.S., Frankel R.M. (2006). Hello, Stranger: building a healing narrative that includes everyone. Academic Medicine 81: 415–418CrossRefGoogle Scholar
  21. Klitzman R. (2006). Improving education on doctor-patient relationships and communication: lessons from doctors who become patients. Academic Medicine 81: 447–453CrossRefGoogle Scholar
  22. Krupat E., Hiam C.M., Fleming M.Z., Freeman P. (1999). Patient-centeredness and its correlates among first year medical students. International Journal of Psychiatry in Medicine 29: 347–356CrossRefGoogle Scholar
  23. Lawton G. (2006). The incredibles. New Scientist 190(2551): 32–8Google Scholar
  24. Leder D. (1990). Clinical interpretation: the hermeneutics of medicine. Theoretical Medicine. 11: 9–24CrossRefGoogle Scholar
  25. Macherey P. (2006). A Theory of Literary Production. London: RoutledgeGoogle Scholar
  26. Masson N., Lester H. (2003). The attitudes of medical students towards homeless people: does medical school make a difference? Medical Education 37: 869–872CrossRefGoogle Scholar
  27. Miettola J., Mantyselka P., Vaskilampi T. (2005). Doctor-patient interaction in Finnish primary health care as perceived by first year medical students. BMC Medical Education 5: 34CrossRefGoogle Scholar
  28. Miller H. (1967). In sickness and in health. Encounter XXVIII(4): 10–21Google Scholar
  29. Miller G.E. (1999). Adventure in pedagogy. Education for Health 12: 339–46Google Scholar
  30. Mukohara K., Ban N., Sobue G., Shimada Y., Otani T., Yamada S. (2006). Follow the patient: process and outcome evaluation of medical students’ educational experiences accompanying outpatients. Medical Education 40: 158–165CrossRefGoogle Scholar
  31. Orr M. (2003). Intertextuality: Debates and Contexts. Cambridge: Polity PressGoogle Scholar
  32. Pauli H.G., White K.L., McWhinney I.R. (2000). Medical Education, Research, and Scientific Thinking in the 21st Century. Education for Health. 13: 165–186CrossRefGoogle Scholar
  33. Phillips S.P., Ferguson K.E. (1999). Do students’ attitudes toward women change during medical school? Canadian Medical Association Journal 161: 127–128Google Scholar
  34. Pinar W., Reynolds W.M., Slattery P., Taubman P.M. (1995). Understanding Curriculum. New York: Peter LangGoogle Scholar
  35. Ryder N., Ivens D., Sabin C. (2005). The attitude of patients towards medical students in a sexual health clinic. Sexually Transmitted Infections 81: 437–439CrossRefGoogle Scholar
  36. Silver-Isenstadt A., Ubel P.A. (1999). Erosion in medical students’ attitudes about telling patients they are students. Journal of General Internal Medicine 14: 481–487CrossRefGoogle Scholar
  37. Tervo R.C., Azuma S., Palmer G., Redinius P. (2002). Medical students’ attitudes toward persons with disability: a comparative study. Archives of Physical Medicine and Rehabilitation 83: 1537–1542CrossRefGoogle Scholar
  38. Thistlethwaite J.E., Jordan J.J. (1999). Patient-centred consultations: a comparison of student experience and understanding in two clinical environments. Medical Education 33: 678–685CrossRefGoogle Scholar
  39. Wahlstrom O., Sanden I., Hammar M. (1997). Multiprofessional education in the medical curriculum. Medical Education 31: 425–429CrossRefGoogle Scholar
  40. Walling A., Montello M., Moser S.E., Menikoff J.A., Brink M. (2004). Which patients are most challenging for second-year medical students? Family Medicine 36: 710–714Google Scholar
  41. Woloschuk W., Harasym P.H., Temple W. (2004). Attitude change during medical school: a cohort study. Medical Education 38: 522–534CrossRefGoogle Scholar
  42. Virno P. (2004). A Grammar of the Multitude. Los Angeles, CA: Semiotext(e)Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Peninsula Medical SchoolUniversities of Exeter and PlymouthExeterUK
  2. 2.Institute of Clinical Education, Peninsula Medical School, Knowledge SpaRoyal Cornwall HospitalTruro, CornwallUK

Personalised recommendations