Patientcentred medical education Drivers and Barriers

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Patient-centred medical education Drivers and
Barriers

• Andreas Hasman, DPhil
• Research Associate
• Picker Institute Europe
• www.pickereurope.org

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Picker Institute Europe

• Patient and staff Survey
• Quality improvement
• Research

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Patient Centred Care

• Involving patients in decisions relating to the
  delivery of treatment and care results in
• Improved patient satisfaction (Farrell, 2004)
• Better clinical outcomes (Wolpert et Andersen,
  2001)
• More effective utilisation of services (Wanless,
  2002)

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What is Patient Centred Medical Education?

• A more involved or engaged role for patients
  requires doctors to
• Partner with patients
• Share decisions
• Provide support for self-care and self-management
• Build health literacy
• Are doctors of today and tomorrow being prepared
  for patient centred medical practice?
• Patient-centred medical education builds the
  capacity in the student or trainee

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Good Medical Practice

• Evidence of a professional move to wards patient
  centred professionalism
• You must respect the right of the patient to be
  fully involved in decisions about their care
• Good communication involves listening to
  patients and respecting their views and beliefs,
  and giving them the information they ask for or
  need about their condition, its treatment and
  prognosis
• (GMC, 2001)

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Tomorrows Doctors

• Students must demonstrate the following attitudes
  and behaviour
• Respect the right of patients to be fully
  involved in decisions about their care, including
  the right to refuse treatment or to refuse to
  take part in teaching or research.
• Recognise their obligation to understand and deal
  with patients' healthcare needs by consulting
  them and, where appropriate, their relatives or
  carers.
• (GMC, 2003)

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Education for Partnership

• What are the dynamics in practice?
• Qualitative interviews with decision-makers
  (n21) in medical education and postgraduate
  training (deans, pg deans, clinical tutors, RC,
  GMC, DoH)
• Is building doctors capacity to involve
  patients a priority in medical education?
• What drives the development towards PCME?
• What prevents it from happening?

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Is PCME a priority?

• Group A recognised the importance of
  prioritising making medical practice more
  patient-centred, but were not sure as to what
  should be done in practice
• Group B recognised the importance of PCME but
  found that medical education and practice is
  already sufficiently patient centred
• Group C didnt find patient-centred care a
  priority in medical education

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• Group A
• When done well, medical education prepares
  doctors for the reality of medical practice and
  practice must develop alongside society.
  Education should enable doctors to adapt to the
  changing needs of society whilst, at the same
  time, remain true to their own values some of
  which will be personal, others will be
  professional.
• Everybody says that it is important to
  communicate well and share decisions and the rest
  of it but it is the practicalities of it that is
  the real challenge a challenge we have yet to
  overcome.

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• Group B
• I dont consider those skills i.e. skills that
  doctors need to involve patients new skills at
  all I cant accept the basic premise that this
  has never happened and now it is happening
• Apart from a poorly performing minority, doctors
  have been involving patients all the time and
  they have done so for at least thirty years.

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• Group C
• Will we accept that doctors technical skills
  and abilities are reduced because they have to
  train their interpersonal skills? Science and
  scientific knowledge must remain at the centre of
  medicine and medical education.

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Drivers and Barriers

• Medical culture
• Tension between training and service
• Insufficient diffusion of innovation from
  research into practice

• It is what patients expect and demand
• It is what students and trainees expect
• Technological developments
• Structural developments

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Drivers to PCME It is what patients want

• Evidence shows that
• patients want more information than they are
  currently given (Coulter Magee, 2003)
• patient preferences for involvement in decision
  making vary with age, gender, education,
  socioeconomic status, illness experience, and the
  gravity of the decision. (Kraetschmer et al.,
  2004)
• Clinicians are not good at accurately assessing
  patients' preferences, while patients may have
  unrealistic expectations about their clinician's
  ability to 'know what is best' for them
  (Robinson and Thomson, 2001)

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Barriers to PCMEMedical culture

• Clinical tutors over-emphasise the importance of
  medical autonomy
• The hidden curriculum remains strong and
  doctor-focused role-models

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Barriers to PCME Lack of diffusion of innovation

• University based research into new teaching and
  assessment methods rarely find their way into
  practice
• Focus in educational research
• The perception of educational research
• Priorities in medical education

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Conclusions and next stages

• PCME is on the agenda in medical education and
  training
• Skills required for PCC are complicated and
  teaching them is not easy
• Addressing the perceived barriers may be an
  important element in overcoming the difficulties
• Next step what is happening and what is working?