How can we optimise medical education to support the development of person-centred values, beliefs and attitudes?
Person-centred care (PCC) is considered central to the delivery of high quality care in the context of long-term conditions, multimorbidity and complexity where evidence suggests it can lead to improved patient outcomes.
Yet current evidence points to an erosion of person-centredness in medical students as they progress through training. This is despite the long-established delivery of person-centred consultation skills training in medical medical schools; leading us to query whether there are gaps in our educational strategy in developing person-centredness.
Behaviour change theories suggest that values, beliefs and attitudes drive actions, so perhaps education strategies need to explicitly focus on these elements in developing professional capacity for PCC. However we don’t yet know how to best educate clinicians for person-centred values, beliefs and attitudes.
We regard education as a complex intervention with multiple component parts and a variety of potential outcomes depending on the interactions between multiple factors. A realist review is particularly suited to investigating complex interventions. Our research question asks: How, why, for whom and in what circumstances educational programmes that aim to promote a person-centred approach change medical professional's values, beliefs and attitudes?
Realist review based on the published RAMESES guidance. With information specialist support we completed a search of key medical and education databases ( MEDLINE, ERIC, EMBASE, HMIC ) and grey literature sources through Boolean combinations of relevant free-text and subject heading terms; limited to papers published from 2000 and in the English language. Inclusion criteria (educational interventions; aimed to change person-centred values, beliefs and attitudes) were applied with double screening of 10% abstracts and full texts to identify final data set. An initial thematic analysis oriented us to the data, before moving to a detailed analysis of Context-Mechanism-Outcome (CMO) configurations to generate our final programme theory.
2494 initial identified abstracts were screened to generate a final data-set of 124 papers
At this interim stage of analysis, we have identified three key themes which suggest that person-centred values, beliefs and attitudes may be supported by:
1. Critical engagement with the values, knowledge, concepts and evidence that underpin the practice of PCC,
2. Reflection on clinical practice that supports transformative learning and self-awareness,
3. Clinical placements and experiences in which students engage with patient narratives and develop partnerships in their relationships with patients and preceptors.
Our final output will be a refined programme theory which will describe the key components of an educational framework to optimise the development of person-centredness in medical students. We expect the findings to have wide curricular implications and to be used to inform, develop and evaluate existing educational strategies.