Abstract
The use of patient educators is one of many teaching strategies meant to foster principles of patient-centred care. We previously found that early patient educator exposure helped to shape the understanding of patient-centredness in pre-clerkship learners. We now expand on this work to evaluate whether there is persistence of initial perceptions and to explore general reflections on longer-term impacts of early patient educator exposures once learners are immersed in the clinical phase of their training. In this follow-up study, we conducted group interviews with a sample of learners who wrote reflections as part of their pre-clerkship patient educator experience. We explored how perspectives on patient educators changed over time, and determined which themes identified during pre-clerkship remained relevant to clinical trainees. Audio recordings were transcribed and analyzed thematically using a hybrid inductive and deductive analysis to construct a thematic framework derived through a method of constant comparison. We identified three new themes: “value of early clinical experience”, “change in learners’ perspectives”, and “valuing and applying CanMEDS roles other than Medical Expert”. Themes from pre-clerkship that remained relevant included: “patients’ perspective humanizes disease”, “patients’ experiences with navigating the healthcare system”, “learners’ perceptions of the learning strategy”, and “inaccuracies and inconsistencies in the learning experience.” Many themes identified in pre-clerkship learners remain relevant in early clinical trainees. Further, insights from pre-clerkship experiences with patient educators evolve as learners experience clerkship with definite shifts in emphasis and new perspectives. This work illuminates the utility of patient educators for those considering this strategy for supporting the development of patient-centredness in undergraduate medical education.
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References
Bandura, A. (1977). Social learning theory. Englewood Cliffs, NH: Prentice Hall.
Barley, G. E., Fisher, J., Dwinnell, B., & White, K. (2006). Teaching foundational physical examination skills: Study results comparing lay teaching associates and physician instructors. Academic Medicine, 81(10), S95–S97.
Barr, J., Bull, R., & Rooney, K. (2015). Developing a patient focussed professional identity: An exploratory investigation of medical students’ encounters with patient partnership in learning. Advances in Health Sciences Education, 20(2), 325–338.
Barr, J., Ogden, K., & Rooney, K. (2014). Committing to patient-centred medical education. The Clinical Teacher, 11(7), 503–506.
Bechel, D. L., Myers, W. A., & Smith, D. G. (2000). Does patient-centered care pay off? The Joint Commission Journal on Quality Improvement, 26(7), 400–409.
Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36, 391–409.
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Cook, D. A., & West, C. P. (2013). Perspective: Reconsidering the focus on “outcomes research” in medical education: A cautionary note. Academic Medicine, 88(2), 162–167.
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage.
Delaney, L. J. (2017). Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), 119–123.
Diemers, A. D., Dolmans, D. H., Verwijnen, M. G., Heineman, E., & Scherpbier, A. J. (2008). Students’ opinions about the effects of preclinical patient contacts on their learning. Advances in Health Sciences Education, 13(5), 633–647.
Duffy, J. M., Chequer, S., Braddy, A., Mylan, S., Royuela, A., Zamora, J., et al. (2016). Educational effectiveness of gynaecological teaching associates: A multicentre randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 123(6), 1005–1010.
Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. The Annals of Family Medicine, 9(2), 100–103.
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 80–92.
Frank, J. R., Snell, L., & Sherbino, J. (Eds.). (2015). CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada.
Gaufberg, E. H., Batalden, M., Sands, R., & Bell, S. K. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine, 85(11), 1709–1716.
Grankvist, O., Olofsson, A. D., & Isaksson, R. (2014). Can physicians be replaced with gynecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden. Patient Education and Counseling, 96(1), 50–54.
Gruppen, L. D., Branch, V. K., & Laing, T. J. (1996). The use of trained patient educators with rheumatoid arthritis to teach medical students. Arthritis & Rheumatology, 9(4), 302–308.
Hojat, M., Mangione, S., Nasca, T. J., Gonnella, J. S., & Magee, M. (2005). Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. The Journal of Social Psychology, 145(6), 663–672.
Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191.
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Jackson, A., Blaxter, L., & Lewando-Hundt, G. (2003). Participating in medical education: Views of patients and carers living in deprived communities. Medical Education, 37(6), 532–538.
Jha, V., Quinton, N. D., Bekker, H. L., & Roberts, T. E. (2009). Strategies and interventions for the involvement of real patients in medical education: A systematic review. Medical Education, 43(1), 10–20.
Kleinman, D. E., Hage, M. L., Hoole, A. J., & Kowlowitz, V. (1996). Pelvic examination instruction and experience: A comparison of laywoman-trained and physician-trained students. Academic Medicine, 71(11), 1239–1243.
Lauckner, H., Doucet, S., & Wells, S. (2012). Patients as educators: The challenges and benefits of sharing experiences with students. Medical Education, 46(10), 992–1000.
Neumann, M., Edelhuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.
Oswald, A., Czupryn, J., Wiseman, J., & Snell, L. (2014). Patient-centred education: What do students think? Medical Education, 48(2), 170–180.
Oswald, A. E., Wiseman, J., Bell, M. J., & Snell, L. (2011). Musculoskeletal examination teaching by patients versus physicians: How are they different? Neither better nor worse, but complementary. Medical Teacher, 33(5), e227–e235.
Perrig, M., Berendonk, C., Rogausch, A., & Beyeler, C. (2016). Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills—A controlled study. BMC Medical Education, 16(1), 35.
Peyton, J. R. (1998). Teaching and learning in medical practice. Rickmansworth, UK: Manticore Europe Ltd.
Pickard, S., Baraitser, P., Rymer, J., & Piper, J. (2003). Can gynaecology teaching associates provide high quality effective training for medical students in the United Kingdom? Comparative study. BMJ, 327(7428), 1389–1392.
Rao, J. K., Weinberger, M., & Kroenke, K. (2000). Visit-specific expectations and patient-centered outcomes: A literature review. Archives of Family Medicine, 9(10), 1148–1155.
Satterfield, J. M., & Hughes, E. (2007). Emotion skills training for medical students: A systematic review. Medical Education, 41(10), 935–941.
Soo, J., Brett-MacLean, P., Cave, M., & Oswald, A. (2016). At the precipice: A prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition. Advances in Health Sciences Education, 21(1), 141–162.
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., et al. (2000). The impact of patient-centered care on outcomes. The Journal of Family Practice, 49(9), 796–804.
Tamblyn, R., Abrahamowicz, M., Dauphinee, D., Wenghofer, E., Jacques, A., Klass, D., et al. (2007). Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA, 298(9), 993–1001.
Towle, A., Bainbridge, L., Godolphin, W., Katz, A., Kline, C., Lown, B., et al. (2010). Active patient involvement in the education of health professionals. Medical Education, 44(1), 64–74.
Vygotsky, L. S. (1980). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
Windish, D. M., Price, E. G., Clever, S. L., Magaziner, J. L., & Thomas, P. A. (2005). Teaching medical students the important connection between communication and clinical reasoning. Journal of General Internal Medicine, 20(12), 1108–1113.
Wykurz, G., & Kelly, D. (2002). Developing the role of patients as teachers: Literature review. BMJ, 325(7368), 818–821.
Acknowledgements
Ethics was approved by University of Alberta Health Research Ethics Office. SF reviewed all the primary data, co-created and revised the thematic frameworks and drafted and edited the manuscript. AT co-conceived the research question and design, reviewed and analyzed the primary data, co-created and revised the thematic frameworks and edited the manuscript. JC collected and reviewed all the primary data, co-created and revised the thematic frameworks and edited the manuscript. AO co-conceived the research question and design, reviewed the primary data, co-created and revised the thematic frameworks and edited the manuscript.
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Appendix: Focus group script
Appendix: Focus group script
Hi everyone. Thank you for coming in today.
I would first like to give you some background on the study we are currently conducting. Up until now medical educators have been relying on patients more frequently to play the role of patient educator as well as to teach students to become more patient centered. Though there are studies that have examined what knowledge or skills patient educators provide to preclinical medical students in order to supplement their medical training, there is little research that looks at what students feel patients bring to their medical education, particularly with regards to providing patient-centered care. There is also limited understanding of which benefits that patient educators provide carry over once students begin their clinical training.
A couple of years ago you submitted a reflective writing assignment for one of your Musculoskeletal courses. For this writing assignment you had to respond to one of four questions about the role that patients play in your medical education. We then read these assignments and identified 5 themes that we felt best represented what you wrote about. Finally, we conducted a couple of focus groups with some of the students in order to confirm whether the themes we identified accurately represented the roles that you felt patients play in your medical education.
We are now conducting a follow up study in order to determine if those 5 roles we initially identified are still present, and in what capacity, now that you are in your 4th year of your program and are in your clinical rotations.
As you may already be aware, anything you say during this focus group will be kept in strict confidence and will not be shared outside of this room. As well, your participation here will be kept anonymous in that each of you will be represented by a randomly selected participant code. Finally, you may choose to withdraw from this study at any point in time. Your participation in these focus groups will in no way affect your past or future grades. Finally, if any of the comments made during this focus group are used in future presentations or publications of the data, they will be presented in an anonymous manner.
Lastly, I will be audio-recording this session so that I can be as accurate as possible when looking at what was said today at a later point in time.
Before we begin, please carefully read and sign this consent form. By consenting you are agreeing to allow us to use the information we collect today for research purposes only.
Q1. Going back to your experiences with patient educators during your preclinical training, what were your initial impressions of these sessions both positive and negative? (If students talk about inaccuracies of what patients teach, ask ‘what would you like to see done differently in order to prevent this from happening?’)
Q2. In what ways do you feel patient educators contributed to your other preclinical experiences? For instance, did your experience with patient educators effect your development from student to doctor?If so, how?
Q3. Do you feel that your experiences with patient educators gave you any insight on the doctor/patient relationship? If so, can you give some examples of this? Has this view changed now that you are finishing your undergraduate medical education?
Q4. In what ways did these patient educators shape how you define patient centered care?
Q5. Now that you are in your clinical training, do you feel any differently about what you came away with from those patient educator sessions?
Q6. Now I am going to go over each of the 5 themes that we identified as part of the previous study, one by one. Each theme represents a role that you felt patients and/or patient educators played in supplementing your medical education. I will read you the theme and then ask you to give me your feedback on how this theme may or may not still play a role in this stage of your medical education, especially with regards to your clinical training.
With each theme ask: Do you see this theme as being more or less relevant now that you are in this stage of your medical education?
(Theme 1, Theme 2, Theme 3, Theme 4, Theme 5. )
Q7. How many patient educator sessions have you had up until now? (If necessary) were these sessions different? (If not different) what would you like to see differently from these sessions at this level of your training?
Q8. Looking back now, is there anything you would change about these patient educator sessions or anything you would want to see done differently?
Q9. Do you have anything else to add regarding your experiences with patient educators?
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Fong, S., Tan, A., Czupryn, J. et al. Patient-centred education: How do learners’ perceptions change as they experience clinical training?. Adv in Health Sci Educ 24, 15–32 (2019). https://doi.org/10.1007/s10459-018-9845-y
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DOI: https://doi.org/10.1007/s10459-018-9845-y