Medical students' learning of the consultation and the patient-doctor relationship
Abstract
Background: In medical education, learning about the consultation and the patient-doctor relationship is nowadays highly recommended. However, research from educational practice from students’ perspective is needed to facilitate a better understanding of students’ learning. The thesis is based on four studies.
Aims: The overall aims were to study and analyse medical students’ learning of the consultation and patient-doctor relationship. Specific aims were to analyse students’ descriptive evaluations of a Consultation skills course and course development over five years (I), to explore final-year students’ abilities to communicate with patients (II), to analyse final-year students’ written reflective accounts of a memorable consultation (III), to assess students’ patient-centred attitudes at various stages of undergraduate medical education and to explore the association between patient-centred attitudes and gender, age and work experience in health care (IV).
Method: A qualitative content analysis method was used in studies I-III, covering term 5 and term 10 (T5, T10). T5 students’ descriptive evaluations and teachers’ documentation were analysed 1995-1999. Experienced supervisors assessed T10 students’ communication abilities in video consultations with patients and supervisors’ focus group meetings were analysed. T10 students’ written reflective accounts of a memorable consultation were analysed. A cross-sectional study of students’ patient-centred attitudes was performed across the curriculum by an internationally validated instrument (Patient-Practitioner Orientation Scale, PPOS). Students’ gender, age and earlier work experience in health care were also collected and analysed statistically.
Results: Learning of the consultation was facilitated when the T5 student was active in practice and could have a choice, by a link between explicit learning goals, learning activities and an examination in practice including feedback. Students’ descriptions of awareness and confidence corresponded to a strengthened relation with the facilitator and reflection. In exploring T10 students’ video consultations, an instrumental strategy was suggested as a stage in students’ consultation training. However, analysis of T10 students’ written reflective accounts of a memorable consultation displayed a view of the patient as a person beyond symptoms, an insight into the complexity of medical work and students’ search for a professional role. In contrast to previous reports, no decline of students’ patient-centred attitudes at the end of education was found. Independent of age or work experience in health care, female students had higher PPOS scores compared to men. Female students also had significantly more work experience in health care.
Conclusions: Students’ learning of the skills and attitudes needed for the consultation and the patient-doctor relationship is complex. Senior students display patient-centeredness in writing but might have difficulties in integrating their know-how with the performance of physician’s clinical tasks. Learning the consultation and the patient –doctor relationship is suggested to benefit from integrating a patient-centred perspective in a student-centred learning relationship through clinical education; and by adopting a process-oriented and experience-based model including feedback and reflection.
Parts of work
I. Wahlqvist M, Skott A, Björkelund C, Dahlgren G, Lonka K, Mattsson B. Impact of medical students' descriptive evaluations on long-term course development. BMC Med Educ 2006;25:6.::DOI::10.1186/1472-6920-6-24 II. Wahlqvist M, Mattsson B, Dahlgren G, Hartwig-Ericson M, Henriques B, Hamark B, Hösterey-Ugander U.Instrumental strategy: A stage in students' consultation skills training? Observations and reflections on students' communication in general practice consultations. Scand J Prim Health Care 2005;23:164-70.::DOI::10.1080/02813430510018646 III. Svenberg K, Wahlqvist M, Mattsson B. ”A memorable consultation”. Writing reflective accounts articulates students' learning in general practice. Scand J Prim Health Care, published on-line 19 Feb 2007. IV. Wahlqvist M, Gunnarsson RK, Dahlgren G, Nordgren S.Patient-centred attitudes among medical students: Gender and work experience in health care do matter. (Manuscript)
Degree
Doctor of Philosophy (Medicine)
University
Göteborg University. Sahlgrenska Academy
Institution
Inst of Medicine. Dept of Public Health and Community Medicine
mats.wahlqvist@allmed.gu.se
Date
2007-05-04Author
Wahlqvist, Mats
Keywords
medical students, learning consultation skills, patient-doctor relationship, communication skills, patient-centred attitudes, undergraduate medical education, experience-based learning model, reflection, evaluation
Publication type
Doctoral thesis
ISBN
978-91-628-7164-2
Language
eng