Common concepts in separate domains? Family physicians’ ways of understanding teaching patients and trainees, a qualitative study

BMC Medical Education

Joanna Bates²  Ian Scott²  Mattias Berg¹  Terese Stenfors-Hayes³ 

[1] Department of Emergency medicine, University of British Columbia, Vancouver, BC, Canada;Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm 171 77, Sweden

关键词: Faculty development;    Trainee;    Qualitative research;    Physician;    Patient;    Family medicine;   

Others  :  1224520
DOI  :  10.1186/s12909-015-0397-z

 received in 2014-12-12, accepted in 2015-06-19,  发布年份 2015

【 摘 要 】

Background

Medical education is increasingly expanding into new community teaching settings and the need for clinical teachers is rising. Many physicians taking on this new role are already skilled patient educators. The purpose of this research was to explore how family physicians conceptualize teaching patients compared to the teaching of trainees. Our aim was to understand if there is any common ground between these two roles in order to support faculty development based on already existing skills.

Methods

Semi-structured interviews with twenty-five family physician preceptors were conducted in Vancouver, Canada and thematically analyzed.

Results

We identified four key areas of overlap between the two fields (being learner-centered; supporting the acquisition, application and integration of knowledge; role modeling and self-disclosure; and facilitating autonomy) and three areas of divergence (aim of teaching and setting the learning objectives; establishing rapport; and providing feedback).

Conclusions

Finding common ground between these two teaching roles would support knowledge translation and inquiry between the domains of teaching patients and trainees. It would furthermore open up new avenues for improving training and practice for clinical teachers by better linking faculty development and continuing medical education (CME).

【 授权许可】

   
2015 Stenfors-Hayes et al.

【 参考文献 】

• [1]AFMC: Mapping undergraduate distributed medical education in Canada. The Association of Faculties of Medicine of Canada (AFMC) 2010
• [2]Nutter D, Whitcomb M: The AAMC project on the clinical education of medical students. Association of American Medical Colleges (AAMC) 2001
• [3]Mallon WT. Medical school expansion: deja vu all over again? Acad Med J Assoc Am Med Coll. 2007; 82(12):1121-5.
• [4]Strasser RP, Lanphear JH, McCready WG, Topps MH, Hunt DD, Matte MC. Canada’s new medical school: the northern Ontario school of medicine: social accountability through distributed community engaged learning. Acad Med J Assoc Am Med Coll. 2009; 84(10):1459-64.
• [5]Howe A, Campion P, Searle J, Smith H. New perspectives--approaches to medical education at four new UK medical schools. BMJ. 2004; 329(7461):327-31.
• [6]Wass V. Growing your own. Educ Prim Care. 2005; 16:215-6.
• [7]Thistlethwaite JE, Kidd MR, Hudson JN. General practice: a leading provider of medical student education in the 21st century? Med J Aust. 2007; 187(2):124-8.
• [8]AFMC: Canadian medical education statistics. The Association of Faculties of Medicine of Canada (AFMC) 2012, 34.
• [9]Krupa LK, Chan B. Canadian rural family medicine training programs. Can Fam Physician. 2005; 51:852-3.
• [10]Bunton S, Sabalis R, Sabharwal R, Candler C, Mallon W: Medical school expansion: challenges and strategies. In Association of American Medical Colleges (AAMC); 2008.
• [11]AAMC: results of the 2009 medical school enrollment survey report to the council of deans. In Association of American Medical Colleges (AAMC); 2010.
• [12]Frank J: The CanMEDS 2005 physician competency framework. Better standards. Better Physicians. Better Care. Royal College of Physicians and Surgeons of Canada; 2005.
• [13]Ross MT. Learning about teaching as part of the undergraduate medical curriculum: perspectives and learning outcomes. The University of Edinburgh, Edinburgh; 2012.
• [14]Liason Committe in Medical Education Accreditation standards and explanatory annotations. https://www. meded.umn.edu/lcme/documents/LCME_Accred_Stds_for_retreat_cases.pdf webcite
• [15]Tomorrow’s doctors: outcomes and standards for undergraduate medical education. General Medical Council, London; 2009.
• [16]Teherani A, O’Brien B, Masters D, Poncelet A, Robertson P, Hauer K. Burden, responsibility, and reward: preceptor experiences with the continuity of teaching in a longitudinal integrated clerkship. Ac Med. 2009; 84:s50-3.
• [17]Daly M, Perkins D, Kumar K, Roberts C, Moore M. What factors in rural and remote extended clinical placements may contribute to preparedness for practice from the perspective of students and clinicians? Med Teach. 2013; 35(11):900-7.
• [18]Cook DA: Study of clinical teachers in canadian faculties of medicine. Association of Faculties of Medicine of Canada AFMC 2009.
• [19]Eiff MP, Waller E, Fogarty CT, Krasovich S, Lindbloom E, Douglass AB et al.. Faculty development needs in residency redesign for practice in patient-centered medical homes: a P4 report. Fam Med. 2012; 44(6):387-95.
• [20]Von Fragstein M, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C. UK consensus statement on the content of communication curricula in undergraduate medical education. Med Ed. 2008; 42(11):1100-7.
• [21]Aspegren K: BEME Guide No . 2 : Teaching and learning communication skills in medicine -a review with quality grading of articles. Medical Teacher. 1999; 21(6):563–570.
• [22]Dandavino M, Snell L, Wiseman J. Why medical students should learn how to teach. Med Teach. 2007; 29(6):558-65.
• [23]Cohen S, Dennick R. Applying learning theory in the consultation. Clin Teach. 2009; 6:117-21.
• [24]D’Ivernois JF, Albano MG. Therapeutic patient education: a new deal for medical education? Med Teach. 2010; 32(12):945-6.
• [25]Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J et al.. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ. 2012; 46(11):1028-41.
• [26]Marton F. Sameness and difference in transfer. J Learn Sci. 2006; 15(4):449-535.
• [27]Karg A, Boendermaker PM, Brand PL, Cohen-Schotanus J. Integrating continuing medical education and faculty development into a single course: effects on participants’ behaviour. Med Teach. 2013; 35(11):e1594-7.
• [28]Langlois JP, Thach SB. Bringing faculty development to community-based preceptors. Acad Med J Assoc Am Med Coll. 2003; 78(2):150-5.
• [29]Marton F, Pang MF. On some necessary conditions of learning. J Learn Sci. 2006; 15(2):193-220.
• [30]Van Merriënboer JJG, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Med Ed. 2010; 44(1):85-93.
• [31]Cousin G. Research learning in higher education. Routledge, London; 2009.
• [32]Wahlström R, Beermann B, Dahlgren LO, Diwan V. Changing primary care doctors’ conceptions - a qualitative approach to evaluating an intervention. Adv Health Sci Educ Theory Pract. 1997; 2:221-36.
• [33]Laine C, Davidoff F. Patient-centered medicine. JAMA. 1996; 275(10):152-6.
• [34]Weston WW. Patient-centered medicine: a guide to the biopsychosocial model. Fam Syst Health. 2005; 23(4):387-92.
• [35]Vygotsky L: Mind in society: The development of higher psychological processes. In., edn. Edited by Cole M, John-Steiner V, Scribner S, Souberman E. Cambridge, MA: Harvard University Press; 1978.
• [36]Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983; 51(3):390-5.
• [37]Wright S. Examining what residents look for in their role models. Ac Med. 1996; 71(3):290-2.
• [38]der Jochemsen-van Leeuw HGR, Van Dijk N, Van Etten-Jamaludin FS, Wieringa-de Waard M. The attributes of the clinical trainer as a role model: a systematic review. Ac Med. 2013; 88(1):26-34.
• [39]Balmer DF, Richards BF. Faculty development as transformation: lessons learned from a process-oriented program. Teach Learn Med. 2012; 24(3):242-7.
• [40]Mcdaniel SH, Beckman HB, Morse DS, Silberman J, Seaburn DB, Epstein RM. Physician self-disclosure in primary care visits. Arch Intern Med. 2013; 167:1321-6.
• [41]Beach MC, Roter D, Rubin H. Is physician self-disclosure related to patient evaluation of office visits? J Gen Intern Med. 2004; 19:905-10.
• [42]Andersson R, Funnell M. Patient empowerment: myths and misconceptions. Patient Educ Couns. 2009; 79:277-82.
• [43]Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psych Rev. 1977; 84(2):191-215.
• [44]Ten Cate O, Snell L, Mann K, Vermunt J. Orienting teaching toward the learning process. Ac Med. 2004; 79(3):219-28.
• [45]Bowen J. Educational strategies to promote clinical diagnostic reasoning. New Eng J Med. 2006; 355:2217-25.
• [46]Stickrath C, Aagaard E, Anderson M. MiPLAN: a learner-centered model for bedside teaching in Today’s academic medical centers. Ac Med. 2013; 88(3):13-6.
• [47]Lorig K, Holman H. Self-management education: definition, outcomes and mechanism. Ann Beh Med. 2003; 26(1):1-7.
• [48]Aujoulat I, d’Hoore W, Deccache A. Patient empowerment in theory and practice: polysemy or cacophony. Patient Educ Couns. 2007; 66:13-20.
• [49]DiMatteo M. A social-psychological analysis of physician-patient rapport: toward a science of the art of medicine. J Soc Issues. 1975; 35:12-33.
• [50]Tate P. The doctor’s communication handbook. 6th ed. Radcliffe Publishing Ltd., Oxon; 2009.
• [51]Ogle KD, Boulé R, Boyd RJ, Brown G, Cervin C, Dawes M et al.. Family medicine in 2018. Can Fam Physician. 2010; 56(4):313-5.
• [52]Goertzen J, Stewart MA, Weston WW. Effective teaching behaviors or rural family medicine preceptors. Can Med Assoc. 1995; 153(2):161-8.
• [53]Neighbour R. The inner apprentice: an awareness-centred approach to vocational training for general practice. 2nd ed. Radcliffe Medical Press, Abingdon; 2004.
• [54]Evans DE, Alstead EM, Brown J. Applying your clinical skills to students and trainees in academic difficulty. Clin Teach. 2010; 7(4):230-5.
• [55]Raven BH. The bases of power and the power/interaction model of interpersonal influence. Anal Soc Issues Public Policy. 2008; 8(1):1-22.
• [56]Hodges B, Albert M, Arweiler D, Akseer S, Bandiera G, Byrne N et al.. The future of medical education: a Canadian environmental scan. Med Educ. 2011; 45(1):95-106.
• [57]Hauer KE, Hirsh D, Ma I, Hansen L, Ogur B, Poncelet AN et al.. The role of role: learning in longitudinal integrated and traditional block clerkships. Med Ed. 2012; 46(7):698-710.
• [58]Sambunjak D, Straus SE, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med. 2010; 25(1):72-8.
• [59]Hauer KE, O’Brien BC, Hansen LA, Hirsh D, Ma IH, Ogur B et al.. More is better: students describe successful and unsuccessful experiences with teachers differently in brief and longitudinal relationships. Ac Med. 2012; 87(10):1389-96.
• [60]Ramani S, Krackov SK. Twelve tips for giving feedback effectively in the clinical environment. Med Teach. 2012; 34(10):787-91.
• [61]Norcini J. The power of feedback. Med Ed. 2010; 44:16-7.
• [62]Holmboe E, Yepes M, Williams F, Huot S. Feedback and the mini clinical evaluation exercise. J Gen Intern Med. 2004; 19:558-61.
• [63]Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007; 29:855-71.
• [64]Stenfors-Hayes T, Scott I, Bates J: Family physicians’ ways of understanding the two solitudes of clinical teaching [abstract]. Quebec: Canadian Conference on Medical Education (CCME); 2013.
• [65]Stenfors-Hayes T, Scott I, Bates J: Doctors teaching patients and trainees: finding common ground [abstract]. Prague: Association of Medical Education in Europe (AMEE); 2013.
• [66]Sorinola OO, Thistlethwaite J. A systematic review of faculty development activities in family medicine. Med Teach. 2013; 35(7):e1309-18.