Teaching routine person-centred practice in medical education through medicines optimisation: A realist review

Abstract

Background: Multimorbid patients are not well served by a narrow biomedical disease-focused approach to health care. The situation calls for a paradigm shift in health care practice towards an interpretive, person-centred model. Medical educators urgently need to teach medical students how to integrate biomedical and interpretive approaches to illness but practical pedagogy in the field is lacking. Medicines optimisation (MO), which encompasses deprescribing, provides an everyday case study of a curriculum theme requiring the everyday integration of potentially dissonant illness perspectives to achieve learning applicable for clinical practice. By clarifying 'what works, for whom, under what circumstances, how and why' in MO education, we can better support the practical integration of dissonant illness perspectives in wider medical education.

Method: A realist review was conducted in keeping with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines identifying MO educational interventions trialled in undergraduate medical curricula globally and developing a programme theory (PT) illuminating the contexts, mechanisms and outcomes related to these interventions. Databases including Medline, Embase, Scopus and ERIC were searched. Inclusion criteria focused on undergraduate MO/deprescribing educational interventions and were iteratively adjusted for PT development.

Results: Analysis of 56 documents highlighted four key components needed to integrate biomedical and interpretive illness perspectives: the role of stakeholder perceptions influencing prioritisation, resource allocation and engagement; meaningful inclusion into summative assessments; learners' appreciation of their professional role and responsibility; and alignment of programmes with workplace and institutional culture.

Discussion: Our PT uniquely unpacks the black-box of undergraduate MO educational programmes and will be developed through subsequent evaluations. The PT provides insight for educators in clinical pharmacology and more widely as an exemplar of education requiring the practical integration of biomedical and interpretive illness perspectives required of modern practitioners.