Theme
Patient Safety
INSTITUTION
Karolinska Institutet
University of British Columbia
The demands and formal requirements on physicians to teach patients and trainees are increasing. These two fields are treated separately in the literature and in the training of physicians. If the two activities of teaching patients and trainees are similar, then a common conceptual framework would open up new avenues for improving the training and practice in both domains.
In this study we explored how family physicians conceptualize key aspects of teaching patients and teaching trainees and identify the similarities and differences between them.
Data collections
-
Observations of physicians and/or trainees interacting with patients
-
Observations of physicians and trainees interacting with each other (no patient present)
-
Interviews with 13 (of 14) physicians:
-
3 men, 10 women
-
All family physicians
-
30-60 years
-
1-14 years of experience at this teaching clinic
The data was analyzed from the perspective of teaching patients and teaching trainees. Once the two sets of themes were established, we synthesized them and extracted the similarities and differences between them through an iterative process.
.jpg)
How family physicians conceptualize the teaching of patients and trainees respectively in their clinical practice
-Identified themes and illustrative quotes:
Similarities
Being learner-centered:
I usually ask them, what do they think is going on? (p)
It just feels like you just have to know where the person is, and if you don’t know that, then there’s no point. (t)
Supporting the acquisition, application and integration of knowledge:
Their knowledge is very good. Very good. That’s not the issue. It’s knowing how to apply it. (t)
A translator of the information (that the patient has brought) and what that means to the patient. Working through what that is, or an interpreter or navigator. (p)
Role modeling and self-disclosure:
I think it helps the learner to see that you understand the challenges that they’re having because you had similar challenges. (p)
Sometimes I know the answer, but I say, “Let’s look this up,” because I want to model it. (t)
Facilitating autonomy:
Letting go of the reins and allowing the learner to work through things. (t)
It’s the patient who needs to really identify what he or she needs. (p)
Differences
The aim of teaching and learning objectives:
If the patient does not want to know they don’t have to know. (p)
I think we really do focus on the learner and the growth of that learner in the role-- in his or her role of becoming a family physician. (t)
Providing feedback (with trainees only):
Being able to reflect back on what they’ve done and say, this is what’s changed, this is what hasn’t changed, this is what you’ve learned.(t)
Establishing rapport (with patients only):
You know, a 60-year old woman has lived in the world for a long time, she is not going to take the advice of a 25 year old person unless that person has created some alliance. (p)
Comparing and contrasting these two domains can facilitate the implementation and effectiveness of undergraduate training, faculty development and CPD and may be a way to decrease physician cognitive load in teaching and learning to teach, if elements of these two roles can be seen as similar.
Increased understanding of teaching patients and trainees will also help advance education research, practice and care delivery, independent of whether the learner is a trainee or a patient.
This study was founded by British Columbia College of Family Physicians Research Awards Fund and Research & Education Foundation Faculty Development Initiatives Grant Program at University of British Columbia
Post your comments
Send Email