Interrogating patient-centredness in undergraduate medical education using an integrated behaviour model

Inclusion of person-centred care in UK postgraduate medical education curricula: Interviews and documentary analysis

BACKGROUND

Person-centred care (PCC) involves placing people at the centre of their healthcare decision making to ensure it meets their needs, values, and personal circumstances. Increasingly, PCC is promoted in healthcare policy and guidance, but little is known about how this is embedded in postgraduate medical training. The aim of this research was to understand how PCC is embedded in UK postgraduate medical training and explore factors influencing inclusion of PCC in curricula content.

METHODS

To explore this, we interviewed senior professionals with key roles in the curricula from four UK Royal Colleges (Psychiatrists; Physicians; Surgeons; and GPs) and used framework analysis on interviews and relevant curricula documents to identify themes.

RESULTS

Legislation and professional/educational guidance influenced inclusion. PCC definitions and terminology differed and placement within curricula was variable. Royal Colleges defined the curriculum and provided training to ensure competence, but local deaneries independently implemented the curriculum. Trainer engagement was greater than trainee buy in. Quality assurance focused on feedback from trainers and trainees rather than patients, and patient and public involvement in curriculum development, teaching, and assessment was limited.

CONCLUSIONS

There is a need for cross-organisation collaboration to develop a PCC competence framework that defines the skills and level of competence required at different points in training, with clarity around the differences between undergraduate and postgraduate requirements. Greater auditing and quality assurance of programme delivery would help identify successful practices to share within and across Royal Colleges, while still maintaining the flexibility of local provision. Engagement with patients and the public in this work can only strengthen provision.

Inclusion of person-centred care in medical and nursing undergraduate curricula in the UK: Interviews and documentary analysis

OBJECTIVE

We aimed to understand how person-centred care (PCC) is represented in UK professional standards for undergraduate medical/nursing education and explored how these are reflected in programme provision.

METHODS

We identified PCC components in medical (GMC) and nursing (NMC) professional standards and university curricula documents provided. We also identified themes from interviews with high-level informants for medical/nursing undergraduate programmes using framework analysis.

RESULTS

The GMC appears to promote a more paternalistic model of care with discrete PCC components in specific sections and the NMC a more collaborative model with PCC distributed throughout. These differences persisted into education delivery. Medical educators perceived greater barriers to inclusion of PCC than nursing educators; however, both consistently identified cultural and organisational attributes. Clarity was lacking regarding PCC definition, how to teach/assess PCC, and competence expectations.

CONCLUSION

Development of a PCC skills competence framework would increase consistency and support teaching and assessment in undergraduate curricula. Further research to understand the perspectives of healthcare professionals involved in placements would help inform PCC teaching recommendations.

PRACTICE IMPLICATIONS

High-level support from senior HEI leaders; multi-disciplinary approaches to curricula development, teaching, and assessment; and greater inclusion of service users would ensure higher quality PCC education for undergraduate students.

"We learnt it, then we lived it": Influencing medical students' intentions toward rural practice and generalist careers via a socially-accountable curriculum

OBJECTIVE

The James Cook University (JCU) medical school has a mission to produce graduates committed to practising with underserved populations. This study explores the views of final-year students regarding the influence of the JCU medical curriculum on their self-reported commitment to socially-accountable practice, intentions for rural practice, and desired postgraduate training pathway.

METHODS

Cross-sectional survey of final year JCU medical students (n = 113; response rate = 65%) to determine whether their future career directions (intentions for future practice rurality and postgraduate specialty training pathway) are driven more by altruism (commitment to socially accountable practice/community service) or by financial reward and/or prestige.

RESULTS

Overall, 96% of responding students reported their JCU medical course experiences had cultivated a greater commitment towards 'socially-accountable' practice. A commitment to socially-accountable practice over financial reward and/or prestige was also significantly associated with preferring to practise Medicine in non-metropolitan areas (p = 0.036) and intending to choose a 'generalist' medical discipline (p = 0.003).

CONCLUSIONS

The findings suggest the JCU medical curriculum has positively influenced the commitment of its graduating students towards more socially accountable practice. This influence is a likely result of pre-clinical teachings around health inequalities and socially-accountable medical practice in combination with real-world, immersive experiences on rural and international placements.