Title
Design and evaluation of a learning assignment In the undergraduate medical curricula on the four dimensions of care: a mixed method study
Summary
To learn about the four dimensions of medical students interviewed a chronically ill or palliative care patient about the four dimensions of care during a fifth-year internship. They then wrote a report and a critical reflection of their interview, provided and received peer feedback on the reports and discussed their experiences within their group. Both students and teachers valued the assignment. It taught students to talk to patients about the four dimensions of care. Students were positive about the authenticity of the assignment (i.e., interviewing a real patient), the peer feedback and the reflection in the group session. The assignment gave them knowledge of communication techniques and helped them to see the diversity of illnesses and the ways patients cope. In their reports, students emphasised the relationship between the illness and the patient’s daily life, but rarely reflected on the potential relationship between the four dimensions of care and the care decisions made. This study confirmed that medical students can practice talking about the four dimensions of care with a chronically ill or palliative patient during their internship, although they find the spiritual dimension the most difficult to discuss. This learning task was received can be implemented in existing internships with relatively little time and effort needed.
Abstract
Background
Chronic and palliative care are rapidly gaining importance within the physician’s range of duties. In this context, it is important to address the four dimensions of care: physical, psychological, social, and spiritual. Medical students, however, feel inadequately equipped to discuss these dimensions with the patient. To bridge this gap, a new assignment was developed and implemented, in which students talked to a chronic or palliative patient about the four dimensions of care during an internship. This study, reports the evaluation of this assignment by students and teachers using a design-based approach.
Methods
Mixed methods were used, including a) student questionnaires, b) student focus
groups, c) teacher interviews, and d) student’s written reflections. Two researchers performed analyses of the qualitative data from the focus groups, interviews, and written reflections using qualitative research software (ALTLAS.TI). Descriptive statistics were computed for the quantitative data using SPSS 21.0.
Results
Students and teachers valued talking to an actual patient about the four dimensions of care. Reading and providing peer feedback on each other’s reports was considered valuable, especially when it came to the diversity of illnesses, the way that patients cope and communication techniques. The students considered reflection useful, especially in the group and provided it was not too frequent. All the dimensions were addressed in the interviews, however the spiritual dimension was found to be the most difficult to discuss. The analysis of the written reflections revealed an overlap between the social and spiritual dimensions. Students pay a lot of attention to the relationship between the illness and the patient’s daily life, but the reflections do often not show
insight in the potential relationship between the four dimensions and decisions in
patient care.
Conclusions
During internships, medical students can practice talking about four dimensions of care with a chronically ill or palliative patient. Due to the format, it can be implemented across existing internships with relatively little extra time and effort. Reflection, peer feedback, and group discussion under the guidance of a teacher are important additions.
