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Thoughtful questions as new pedagogy for teaching patient centred care: A pilot study in an Australian Rural Clinical School (RCS)

Abstract

Michael Buist, Sarah Middleton

Introduction: The taking of the patient medical history is at the heart of the doctor patient relationship. It is often critical for a diagnosis and also plays an important part in ongoing clinical care of the patient. However, with the move away from assessment by “long case” to the Objective Structured Clinical Examination (OSCE), medical students spend less time with patients and when they do take a history it is done in a didactic checklist manner. This learning is contrary to the needs of the now more health literate patient. Methods: By an iterative process, we developed a program of teaching medical history at the bedside of real patients that focussed on listening to what the patient said as opposed to the traditional history checklist. By anonymous online survey we sought feedback from the students on this way teaching. Results: Over the 3 years of this program (from 2013) 76 of the 85 students responded to the survey (89% response rate). Students were mostly receptive to the ideas of following up on clues and information that patients gave them and then presenting this information in a more interesting way to peers. However, there was less enthusiasm, for taking the history in a more casual but patient centred way. Conclusion: This program was feasible and welcomed by the students. The major limitations were that students were frustrated by not being taught examinable OSCE cases and that the time commitment by the clinician was onerous.

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