Yaw-Wen Chang1,2, David A Hirsh3,4, Wen-Hui Fang1, Honghe Li5, Wen-Chii Tzeng6, Senyeong Kao7. 1. Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China. 2. Graduate Institute of Medical Science, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist.,, Taipei City, 11490, Taiwan, Republic of China. 3. Harvard Medical School Academy, Tosteson Medical Education Center, Room 384, 260 Longwood Ave, Boston, MA, 02115, USA. 4. HMS-Cambridge Integrated Clerkship, Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA. 5. Institute of International Healthcare Professionals Education and Research, China Medical University, No.77, Puhe Rd., Shenyang North New Area, Shenyang, Liaoning, P.R. China. 6. School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China. 7. Graduate Institute of Life Science, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China. kao@mail.ndmctsgh.edu.tw.
Abstract
BACKGROUND: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context. METHODS: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students. RESULTS: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood. CONCLUSION: In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.
BACKGROUND: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context. METHODS: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students. RESULTS: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood. CONCLUSION: In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.
Entities:
Keywords:
Continuity; East Asia; Empathy; Longitudinal integrated clerkship; Medical student; Patient centered; Patient perception; Professionalism; Qualitative study; Relationship; Undergraduate medical education
Authors: Robert J Flick; Caitlin Felder-Heim; Jennifer Gong; Janet Corral; Kathryn Kalata; Alejandro Marin; Jennifer E Adams Journal: Acad Med Date: 2019-11 Impact factor: 6.893
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