Patient-centred consultations: a comparison of student experience and understanding in two clinical environments

Abstract

Objectives: To explore students' perspectives on doctor-patient communication.

Design: We interviewed students in focus groups before and after their placements. In semistructured interviews they were asked about their experiences of learning through clinical contact, with particular emphasis on patient-centred consultations, on the wards and during their community attachment. Students whose clinical skills training remained hospital-based were also interviewed to compare the range of experiences.

Setting: Leeds University.

Subjects: Third-year medical students.

Results: During hospital training students are rarely introduced, either through teaching or observation, to the idea of patient-centred consultations. In contrast both the principles underpinning and/or the practice of such consultations were routinely encountered during the general practice placement. Students considered the community attachment to have helped them appreciate the value of exploring patients' concerns both in terms of enhancing the patients' overall healthcare experience and promoting effective clinical management. While they considered the nature and purpose of hospital care to be qualitatively different from that conducted in the community, the relevance of adopting a patient-centred approach on the wards was confirmed.

Conclusions: Recommendations for clinical training are made. The relevance and best use of community and hospital-based attachments need to be evaluated further.