Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit)
Abstract
:1. Introduction
2. Methods
2.1. Search Strategies
2.2. Inclusion and Exclusion Criteria
Inclusion | Exclusion |
---|---|
Medical students | Health professional students other than medical |
Placements longer than 24 weeks | Placements of less than 24 weeks |
Student access to and continuity of patient population in same location and/or continuity of preceptor/supervisor and meets definition for LIC | No continuity of patients and location and/or preceptor/supervisor and/or does not meet definition for LIC |
Evaluation data relating to effectiveness of placements | No evaluation data relating to effectiveness of placements |
In English | Not in English |
2.3. Strengths and Limitations of Evidence
3. Results and Discussion
3.1. Benefit to Patients
3.1.1. Direct Benefit to Patient Care
“Without me I can confidently say this illiterate, non-English-speaking patient, even with his very supportive and involved family, would have fallen through the cracks. The number of appointments and communications and miscommunications would have been so numerous…that he probably would have just stopped showing up.”—CIC* LIC Student MG [14]
“We both [patient and student] benefited from my long-term relationship with the patient. The patient was a 45–65 year old male with gastrointestinal upset on a background of chronic alcohol abuse, cirrhosis and chronic pancreatitis. This man had been lost to the system and was on a slippery downward slope. I saw him on a regular basis. On the first consultation he was very reserved and quite defensive when questioned about his alcohol consumption, over the year we managed to significantly reduce his alcohol consumption, gain better control of his diabetes and managed to get his to have a colonoscopy, which was a massive task for him.”—UoW** LIC student [22]
“I think literally it was just him asking me questions, seeing how I was doing and genuinely listening. Asking about my wellbeing, as opposed to just checking my pulse and everything else that was happening to me.”—UCSF*** LIC patient 531 [15]
- *: Cambridge Integrated Clerkship, Harvard Medical School.
- **: Graduate School of Medicine, University of Wollongong (UoW).
- ***: University of California, San Francisco (UCSF).
“When you go to see a physician you’re lucky to get the first 10–20 s of the doctor’s attention. I always go in with a list of questions, and I still have a degree of anxiety because I know I won’t get through all the questions before the doctor’s out of there. So it was lovely to have a student take his time and do a good job, and listening, and I think it’s a terrific thing to do.”—UCSF LIC patient 674 [15]
“Long-term is a good idea rather than short-term. You get that personal touch because they [students] have got time to get to know exactly what’s going on.”—UoW rural LIC patient [13]
“One of the students asked me how it affects my life or how I’ve coped and I think it is very important for a patient.”—UoW rural LIC patient [13]
“She [the student] has basically been managing me since I first got out of hospital…she was another doctor but she’s been with me through my whole case with my treating GP…and every time he (GP) would come and consult and it saves a lot of time it’s a better quality of service, cos I was getting two doctors for the price of one.”—UoW rural LIC patient [22]
“Dealing with the ordeal of having cancer and going through treatment at a hospital like UCSF, which is very busy, can be kind of overwhelming at times. I kind of looked to him as a friendly face, sort of a liaison between the doctor and the patient.”—UCSF LIC patient 504 [15]
“She would make phone calls for me, tell me where to show up and tell me what time and who would meet me there. Sometimes she would even meet us over there at the hospital. She facilitated a lot of us getting into the hospital and making things more comfortable.”—UCSF LIC patient 596 [15]
“We had a great talk about everything and I asked him questions and he answered them very professionally. The [student] fulfilled my expectations.”—UoW rural LIC patient [13]
“He [Dr.] went right through with her [student], the questions that she asked, what she had decided should have been the treatment and gave her some suggestions but always while I was present. I appreciated that…yes felt part of the decision-making process. Nothing was hidden, that’s really important.”—UoW rural LIC patient [13]
“I find medical students are just…they’re willing to learn…they’re just a lot more aware of the patient I think sometime. I met her at the beginning of my pregnancy. I went through a few things…you’d come to visit again and she’d be there. It was kind of like she was growing with me…if that makes sense.”—UoW rural LIC patient [22]
“My own GP said it was something he doesn’t see very often. He wanted to give the student an experience of seeing how she went diagnosing. He had a quiet word with me. It was very valuable for all of us because it was me talking to the young student doctor, but having the other doctor behind. He and I knew what the diagnosis was.”—UoW rural LIC patient [13]
“The patient is always involved. It’s not like the doctor takes the student out of the room…the student is there and actually gets involved. I think it’s good because they’re learning a lot, plus the patient is learning trust…some of these students might be here at the surgery later on in life.”—UoW remote LIC patient [13]
“What I’ve observed with both doctors…is the way the doctors support the students…for me it enhances my relationship with the doctor.”—UoW rural LIC patient [13]
3.1.2. Creation of Patient-Centered Physicians
“They [LIC students] are just a lot more aware of the patient I think sometimes.”—UoW rural LIC patient [13]
“I believe very strongly that the profound sense of my unique longitudinal experience with him bonded us together and required me to take responsibility in a way I would not traditionally be asked to do.”—CIC LIC Student AH [14]
“They are polite and they’re thinking of the patient…they are thinking of you and make you comfortable. The students listened to him [6-year-old grandson]. He was only six but he knew more than me and his mother knew because he’d been around with the doctors…he was telling them [students]…they were asking him questions...they weren’t talking to him like he was way down here and they were way up here. It was helpful for my grandson too.”—UoW remote LIC Patient Grandmother [22]
3.1.3. Addressing Workforce Shortages
“It’s maybe taken a bit of a load off her [doctor]…the doctors do work pretty hard.”—UoW rural LIC patient [13]
“I think it definitely a positive and hopefully when they graduate, it gets them back into the country.”—UoW rural LIC patient [13]
“It does contribute to the community…we’ve got additional doctors in a way.”—UoW rural LIC patient [13]
3.2. Benefit to Students
3.2.1. Student Role and Responsibility
“I was able to not only see him in the emergency department, but see him a couple of weeks later in the rheumatology clinic. Immediately, he saw me and he recognized me. He knew that was helping to take care of him in the ED. I was immediately welcomed into his visit and I was even able to share some of his history with the rheumatologist who was seeing him…I felt really useful.”—LIC student (three school study) [19]
“You go in and see a patient that you’ve seen many, many times who knows you very well and you know them very well. You’re checking up on their longstanding diabetes and seeing if they’re still taking their medications, or if they’ve tried walking the extra block or whatever we were working on. That really gave me a sense of being a physician.”—LIC student (three school study) [19]
3.2.2. Clinical Skills and Professional Development
“You can read anything out of a book…totally different…they [student] are getting to see people like me but they’re interacting with all age groups.”—UoW remote LIC patient [22]
4. Conclusions
Acknowledgments
Conflicts of Interest
References
- Norris, T.E.; Schaad, D.C.; de Witt, D.; Ogur, B.; Hunt, D.D.; The Members of the Consortium of Longitudinal Integrated Clerkships. Longitudinal integrated clerkships for predoctoral medical students: An innovation adopted by multiple medical schools internationally. Acad. Med. 2009, 84, 902–907. [Google Scholar] [CrossRef] [PubMed]
- Hudson, J.N.; Farmer, E.A.; Weston, K.M.; Bushnell, J.A. Using a framework to implement large-scale innovation in medical education with the intent of achieving sustainability. BMC Med. Educ. 2015. [Google Scholar] [CrossRef] [PubMed]
- Ogur, B.; Hirsh, D.; Krupat, E.; Bor, D. The harvard medical school-cambridge integrated clerkship: An innovative model of clinical education. Acad. Med. 2007, 82, 397–404. [Google Scholar] [CrossRef] [PubMed]
- Poncelet, A.; Bokser, S.; Calton, B.; Hauer, K.E.; Kirsch, H.; Jones, T.; Lai, C.J.; Mazotti, L.; Shore, W.; Teherani, A.; et al. Development of a longitudinal integrated clerkship at an academic medical center. Med. Educ. Online 2011. [Google Scholar] [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. [Google Scholar] [CrossRef] [PubMed]
- Poncelet, A.; Hirsh, D. Longitudinal integrated clerkships (LIC). In Guidebook for Clerkship Directors, 4th ed.; Morgenstern, B.Z., Ed.; Gegensatz Press: North Syracuse, New York, NY, USA, 2012; pp. 173–224. [Google Scholar]
- Halaas, G.W. The rural physician associate program: Successful outcomes in primary care and rural practice. Rural Remote Health 2005, 5. [Google Scholar] [PubMed]
- Hirsh, D.A.; Ogur, B.; Thibault, G.E.; Cox, M. “Continuity” as an organizing principle for clinical education reform. New Engl. J. Med. 2007, 356, 858–866. [Google Scholar] [CrossRef] [PubMed]
- Bleakley, A.; Bligh, J. Students learning from patients: Let’s get real in medical education. Adv. Health Sci. Educ. Theory Pract. 2008, 13, 89–107. [Google Scholar] [CrossRef] [PubMed]
- Mainous, A.G., 3rd; Goodwin, M.A.; Stange, K.C. Patient-physician shared experiences and value patients place on continuity of care. Ann. Fam. Med. 2004, 2, 452–454. [Google Scholar] [CrossRef] [PubMed]
- Ridd, M.; Shaw, A.; Lewis, G.; Salisbury, C. The patient-doctor relationship: A synthesis of the qualitative literature on patients’ perspectives. J. Roy. Coll. Gen. Pract. 2009, 59, e116–e133. [Google Scholar] [CrossRef] [PubMed]
- Donaldson, M.S. Continuity of care: A reconceptualization. Med. Care Res. Rev. 2001, 58, 255–290. [Google Scholar] [CrossRef] [PubMed]
- Hudson, J.N.; Knight, P.J.; Weston, K.M. Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: A qualitative study. BMC Fam. Pract. 2012. [Google Scholar] [CrossRef] [PubMed]
- Ogur, B.; Hirsh, D. Learning through longitudinal patient care-narratives from the harvard medical school-cambridge integrated clerkship. Acad. Med. 2009, 84, 844–850. [Google Scholar] [CrossRef] [PubMed]
- Poncelet, A.N.; Wamsley, M.; Hauer, K.E.; Lai, C.; Becker, T.; O’Brien, B. Patient views of continuity relationships with medical students. Med. Teach. 2013, 35, 465–471. [Google Scholar] [CrossRef] [PubMed]
- Gaufberg, E.; Hirsh, D.; Krupat, E.; Ogur, B.; Pelletier, S.; Reiff, D.; Bor, D. Into the future: Patient-centredness endures in longitudinal integrated clerkship graduates. Med. Educ. 2014, 48, 572–582. [Google Scholar] [CrossRef] [PubMed]
- Halaas, G.W.; Zink, T.; Finstad, D.; Bolin, K.; Center, B. Recruitment and retention of rural physicians: Outcomes from the rural physician associate program of minnesota. J. Rural Health 2008, 24, 345–352. [Google Scholar] [CrossRef] [PubMed]
- Worley, P.; Martin, A.; Prideaux, D.; Woodman, R.; Worley, E.; Lowe, M. Vocational career paths of graduate entry medical students at flinders university: A comparison of rural, remote and tertiary tracks. Med. J. Aust. 2008, 188, 177–178. [Google Scholar] [PubMed]
- Hauer, K.E.; Hirsh, D.; Ma, I.; Hansen, L.; Ogur, B.; Poncelet, A.N.; Alexander, E.K.; O’Brien, B.C. The role of role: Learning in longitudinal integrated and traditional block clerkships. Med. Educ. 2012, 46, 698–710. [Google Scholar] [CrossRef] [PubMed]
- O’Brien, B.C.; Poncelet, A.N.; Hansen, L.; Hirsh, D.A.; Ogur, B.; Alexander, E.K.; Krupat, E.; Hauer, K.E. Students’ workplace learning in two clerkship models: A multi-site observational study. Med. Educ. 2012, 46, 613–624. [Google Scholar] [PubMed]
- Walters, L.; Greenhill, J.; Richards, J.; Ward, H.; Campbell, N.; Ash, J.; Schuwirth, L.W. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med. Educ. 2012, 46, 1028–1041. [Google Scholar] [CrossRef] [PubMed]
- Hudson, J.N.; Weston, K.M. The benefits of longitudinal relationships with patients for developing health professionals: The longitudinal student-patient relationship. In Health Practice Relationships; Higgs, J.C.A., Tasker, D., Hummell, J., Patton, N., Eds.; Sense Publishers: Rotterdam, The Netherlands, 2014; pp. 211–218. [Google Scholar]
- Thistlethwaite, J.E.; Bartle, E.; Chong, A.A.; Dick, M.L.; King, D.; Mahoney, S.; Papinczak, T.; Tucker, G. A review of longitudinal community and hospital placements in medical education: Beme guide No. 26. Med. Teach. 2013, 35, e1340–e1364. [Google Scholar] [CrossRef] [PubMed]
- Feudtner, C.; Christakis, D.A.; Christakis, N.A. Do clinical clerks suffer ethical erosion? Students’ perceptions of their ethical environment and personal development. Acad. Med. 1994, 69, 670–679. [Google Scholar] [CrossRef] [PubMed]
- Patenaude, J.; Niyonsenga, T.; Fafard, D. Changes in students’ moral development during medical school: A cohort study. Can. Med. Assoc. J. 2003, 168, 840–844. [Google Scholar]
- Self, D.; Baldwin, D.J. Moral reasoning in medicine. In Moral Development in the Professions; Rest, J., Narvaez, D., Eds.; Lawrence Earlbaum: Hillsdale, MI, USA, 1994; pp. 147–162. [Google Scholar]
- Haidet, P.; Dains, J.E.; Paterniti, D.A.; Hechtel, L.; Chang, T.; Tseng, E.; Rogers, J.C. Medical student attitudes toward the doctor-patient relationship. Med. Educ. 2002, 36, 568–574. [Google Scholar] [CrossRef] [PubMed]
- Hafferty, F.W. Beyond curriculum reform: Confronting medicine’s hidden curriculum. Acad. Med. 1998, 73, 403–407. [Google Scholar] [CrossRef] [PubMed]
- Poncelet, A.N.; Hauer, K.E.; O’Brien, B. The longitudinal integrated clerkship. Virtual Mentor. 2009, 11, 864–869. [Google Scholar] [PubMed]
- Krupat, E.; Pelletier, S.; Alexander, E.K.; Hirsh, D.; Ogur, B.; Schwartzstein, R. Can changes in the principal clinical year prevent the erosion of students’ patient-centered beliefs? Acad. Med. 2009, 84, 582–586. [Google Scholar] [CrossRef] [PubMed]
- 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. [Google Scholar] [CrossRef] [PubMed]
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Poncelet, A.N.; Hudson, J.N. Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit). Healthcare 2015, 3, 607-618. https://doi.org/10.3390/healthcare3030607
Poncelet AN, Hudson JN. Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit). Healthcare. 2015; 3(3):607-618. https://doi.org/10.3390/healthcare3030607
Chicago/Turabian StylePoncelet, Ann N., and J. Nicky Hudson. 2015. "Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit)" Healthcare 3, no. 3: 607-618. https://doi.org/10.3390/healthcare3030607