Patient-centred medical education Drivers and Barriers

1. Patient-centred medical education Drivers and Barriers Andreas Hasman, DPhil Research Associate Picker Institute Europe www.pickereurope.org

2. Picker Institute Europe • Patient and staff Survey • Quality improvement • Research

3. Patient Centred Care Involving patients in decisions relating to the delivery of treatment and care results in : Improved patient satisfaction (Farrell, 2004) Better clinical outcomes (Wolpert et Andersen, 2001) More effective utilisation of services (Wanless, 2002)

4. What is Patient Centred Medical Education? A more involved or engaged role for patients requires doctors to: Partner with patients Share decisions Provide support for self-care and self-management Build health literacy Are doctors of today and tomorrow being prepared for patient centred medical practice? Patient-centred medical education builds the capacity in the student or trainee

5. Good Medical Practice Evidence of a professional move to wards patient centred professionalism: “You must respect the right of the patient to be fully involved in decisions about their care” “Good communication involves listening to patients and respecting their views and beliefs, and giving them the information they ask for or need about their condition, its treatment and prognosis” (GMC, 2001)

6. Tomorrow’s Doctors Students must demonstrate the following attitudes and behaviour: • “Respect the right of patients to be fully involved in decisions about their care, including the right to refuse treatment or to refuse to take part in teaching or research. • Recognise their obligation to understand and deal with patients' healthcare needs by consulting them and, where appropriate, their relatives or carers.” (GMC, 2003)

7. Education for Partnership • What are the dynamics in practice? • Qualitative interviews with decision-makers (n=21) in medical education and postgraduate training (deans, pg deans, clinical tutors, RC, GMC, DoH) • Is building doctors’ capacity to involve patients a priority in medical education? • What drives the development towards PCME? • What prevents it from happening?

8. Is PCME a priority? • Group A: recognised the importance of prioritising making medical practice more patient-centred, but were not sure as to what should be done in practice • Group B: recognised the importance of PCME but found that medical education and practice is already sufficiently patient centred • Group C: didn’t find patient-centred care a priority in medical education

9. Group A “When done well, medical education prepares doctors for the reality of medical practice – and practice must develop alongside society. Education should enable doctors to adapt to the changing needs of society whilst, at the same time, remain true to their own values – some of which will be personal, others will be professional.” “Everybody says that it is important to communicate well and share decisions and the rest of it… but it is the practicalities of it that is the real challenge – a challenge we have yet to overcome.”

10. Group B “I don’t consider those skills [i.e. skills that doctors need to involve patients] new skills at all – I can’t accept the basic premise that this has never happened and now it is happening” “Apart from a poorly performing minority, doctors have been involving patients all the time – and they have done so for at least thirty years.”

11. Group C “Will we accept that doctors’ technical skills and abilities are reduced because they have to train their interpersonal skills? Science and scientific knowledge must remain at the centre of medicine and medical education.”

12. It is what patients expect and demand It is what students and trainees expect Technological developments Structural developments Medical culture Tension between training and service Insufficient diffusion of innovation from research into practice Drivers and Barriers

13. Drivers to PCME: It is what patients want Evidence shows that: • patients want more information than they are currently given (Coulter & Magee, 2003) • patient preferences for involvement in decision making vary with age, gender, education, socioeconomic status, illness experience, and the gravity of the decision.(Kraetschmer et al., 2004) “Clinicians are not good at accurately assessing patients' preferences, while patients may have unrealistic expectations about their clinician's ability to 'know what is best' for them” (Robinson and Thomson, 2001)

14. Barriers to PCME:Medical culture • Clinical tutors over-emphasise the importance of medical autonomy • The “hidden” curriculum remains strong and doctor-focused – role-models

15. Barriers to PCME: Lack of diffusion of innovation • University based research into new teaching and assessment methods rarely find their way into practice • Focus in educational research • The perception of educational research • Priorities in medical education

16. Conclusions and next stages • PCME is on the agenda in medical education and training • Skills required for PCC are complicated and teaching them is not easy • Addressing the perceived barriers may be an important element in overcoming the difficulties • Next step: what is happening and what is working?