What do medical students learn when they follow patients from hospital to community? A longitudinal qualitative study

Abstract

ContextAlthough longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital.MethodsThe authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes.ResultsThe most frequent theme was ‘chronic disease management’ (25%) followed by ‘patient-centred care’ (22%), ‘health care systems’ (20.9%), ‘biomedical issues’ (19.7%), ‘community services’ (9.5%) and ‘student’s role conflict’ (2.3%). There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3%) and health systems (18.2%) were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1%) and patient centredness (31.8%) were the dominant themes after the 10-month longitudinal follow-up.ConclusionLongitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.

Final year medical students’ understanding of family medicine

“…When comparing our results to the results of other studies, we were able to conrm that students understand the clinical competences of family doctors (8), but fail to understand some other competences of family doctors (7,(9)(10)(11). In a qualitative research synthesis about medical students' perception of and attitudes towards family medicine, it was found that most of the included studies describe factors which inuence a career choice for family medicine (24).…”

“…In hospital settings there are patients with severe illnesses, requiring a high intensity of care. ere is inadequate opportunity during classroom learning to teach about care continuum, cost e ectiveness, chronic disease management, family and patient perspectives and the impact of the social environment on illness (10).…”

“…Hospital based learning was focused on biomedical knowledge necessary for treating acute ill patients, but long-term care of chronically ill patients should be patient-centered and should take the community into account as well as the individual patient (10).…”

“…We are also aware that to understand speci c problem-solving skills and community orientation, some more experience working in FM and close and long-term contact with patients is required (10,30), but the clerkship should o er at least a basic understanding of these competences.…”

“…Students usually understand the clinical competences of family doctors (8), but fail to understand other competences of family doctors, such as long term care and patient centeredness (9,10), community orientation (7) and medical leadership and management (11).…”