Students’ workplace learning in primary health care : learning from patients

Sammanfattning: Background: Facilitation of patients’ participation in own care is considered key component to achieve a person-centered, high-quality care delivery. Person-centered care, including communication techniques and patient-centered working methods, taking into account the patients’ autonomy and participation in own care, can affect the outcome of the patients’ care and health. For students in health care education, communication and patient-centeredness are important core competencies to practice during workplace learning. In order to achieve adequate professional competences, workplace learning plays an important role in students’ clinical training. Students’ clinical competence and communication skills can be facilitated if the students are given the opportunity to actively, under supervision, provide care during patient encounters. Patients’ active participation in undergraduate education can positively affect their experience of health care and facilitate students’ clinical learning. However, patients are seldom specifically involved in medical students’ clinical education about communication and patient-centeredness. At the same time, patients describe having important knowledge to communicate to medical students to facilitate the students’ clinical learning. Aim: The overall aim of the present thesis was to explore how patients’ participation in clinical education can facilitate medical students’ learning regarding communication skills and patient-centeredness. Method: In Study I, data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale (CLES + T), the Client Satisfaction Questionnaire-8 (CSQ-8), and interviews with clinical supervisors. In Study II, the Patient Feedback in Clinical Practice (PFCP) questionnaire was composed and validated. In Study III, evaluation surveys and interviews were used to explore students’ experiences of their learning from the patients’ written feedback that patients provided on the PFCP questionnaire. In Study IV, students, peers, and clinical supervisors’ experiences of a multi- source feedback (MSF) setting were explored using evaluation surveys. Prior to the data collection for Study IV, semi-structured interviews with students and clinical supervisors and iterated discussions within the authors’ team were conducted to adapt the PFCP questionnaire to enable peers and clinical supervisors to provide feedback and for students to perform self- evaluation. In Studies I–IV, statistical and qualitative content analyses were used to analyze the data. Results: Patients, students, and clinical supervisors at the student-run clinic (SRC) in Study I experienced facilitated student-centered learning and tutoring while maintaining high-quality patient care. The validation process in Study II resulted in the 19-item PFCP questionnaire, which includes two dimensions: consultational approach and transfer of information. The patients, students, and clinical supervisors experienced the content and structure of the PFCP questionnaire in alignment with the consultation, authentically reflecting the patient encounter and capturing the patient’s agenda in the consultation. In Study III, the students experienced the patients’ written feedback, obtained from the PFCP questionnaire, as providing useful information that facilitated a reflective self-directed learning process that identified areas for improvement and further clinical training. In Study IV, the students, peers, and clinical supervisors experienced the written MSF as providing multifaceted perspectives of patient-centeredness that contributed to identifying levels of knowledge and areas for further training. Conclusion: The results of Study I indicate that SRC in primary health care has the potential to enhance student-centered learning and supervision while maintaining high-quality patient care. The results of Study II indicate that the PFCP questionnaire is a valid, reliable, and internally consistent questionnaire for patients’ written feedback to medical students. The results of Study III indicate that patients’ written feedback provided the students with concrete feedback that facilitated the students’ ability to identify levels of knowledge and areas for further clinical training. The results of Study IV indicate that MSF, gathered with the original and adapted PFCP questionnaires and provided adjacent to an encounter, could be an adequate learning activity both for the medical students and their peers. Additionally, increased patient participation in students’ workplace learning could clarify and facilitate clinical supervisors’ pedagogical assignment. The results indicate that the patients’ subjective experience of care visualized the importance of including patients as a valuable resource in students’ workplace learning.