Learning of person-centred practice amongst clinical associate students at the University of Pretoria

Abstract

Aim: This is a study of the extent to which clinical associate students learn person-centred practice (PcP) as well as the curricular elements that may facilitate such learning. Methods: A quality improvement intervention by students on their own medical consultations was explored in focus group discussions. The learning of PcP were analysed using the capability approach framework. PcP was measured in consultations during Objective Structured Clinical Examinations (OSCEs) before and after the intervention in both intervention and control groups. Results: Disruptions to students’ abilities, knowledge, identity and relationships triggered learning. The quality improvement process functioned as a learning cycle scaffolded by peer feedback and assessment tools during which students reviewed disruptions and developed improvement plans. Even though students articulated their passion for PcP in focus groups, few actually demonstrated these skills during OSCE consultations with simulated patients. An increase in PcP was observed but the difference between intervention and control groups was not significant. Students’ sense of self was disturbed when they were unable to help patients. In response, self-directed students devised learning strategies involving relationships with peers and facilitators. Relationships are thus both triggers for learning and a means to learning.

Conclusion and recommendations:

The significantly better improvement in third year students, compared to those in second year, suggest that learning PcP is grounded in increased confidence in biomedical knowledge and skills, motivation and sense of self-efficacy. Students learn and practice PcP best in authentic encounters with real patients. Therefore, student learning and practice of PcP should be evaluated in such encounters and, to achieve PcP, the student-patient relationship needs to be given primacy in professional identity formation as patients and their needs transform student apprentices into caring, solution-seeking clinicians who engage with rather than other patients in the therapeutic alliance.