Listening to the patient: a qualitative exploratory study on peer role-play using outpatients' illness narratives

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.63

Presenter:

Noriyuki Takahashi [1]

Co-authors:

Muneyoshi Aomatsu [1, 2], Takuya Saiki [3], Takashi Otani [4], Nobutaro Ban [1, 5]

Author institutions:

Nagoya University Graduate School of Medicine, Japan [1], Saku Central Hospital, Japan [2], Medical Education Development Center, Gifu University, Japan [3], Graduate School of Education and Human Development, Nagoya University, Japan [4], Aichi Medical University, Japan [5]

Problem

Illness narratives have been associated with methods of improving care that go beyond what may be regarded as a "narrow" view of scientific medicine. Medical interview training in which medical students can understand the importance of illness narratives is receiving increased attention. However, students generally receive education on illness narratives that does not distinguish inpatients and outpatients. Studies exploring the characteristics of outpatients' illness narratives are scarce, and no learning outcomes through peer role-play using outpatients' case scenario have been reported. This study explored what and how medical students learn about the characteristics of outpatients' illness narratives.

Approach

Participants were 70 fifth-year medical students who were in clinical clerkship in the Department of General Medicine, Nagoya University, Japan. We conducted 13 focus groups, based on a convenience sample of 11 groups in 2012, one group in 2013, and one group in 2017 (from 17 clinical groups in each year). Focus group transcripts were analyzed using the "Steps for Coding and Theorization" qualitative data analysis method. We assessed medical anthropological findings regarding illness narratives in a conceptual framework.

Findings

Patients' narratives as perceived by medical students were divided into four quadrants by two axes: medical versus non-medical (lived) context, and objective versus subjective structure. Outpatients' narratives mainly used a subjective structure, but were mixed and crossed each quadrant, which was described as "irreproducibility." In contrast, narratives of simulated patients and inpatients were mainly limited to a medical-lived context with an objective structure. Medical students recognized the differences in narrative characteristics through previous interactions with simulated patients and inpatients.

Consequences

Although there are some limitations, undergraduate peer role-play training using outpatients' narratives enables medical students to learn about patients' narratives in a way that cannot be obtained by training using simulated patients or inpatients.

Submitted by:

Noriyuki Takahashi

Funding acknowledgement:

This study was funded by Grants-in-Aid for Scientific Research, awarded by the Japan Society for the Promotion of Science (grant number 24659239, 2012/4-2015/3).