How to Develop Patient Centred Consulting during Workplace Learning in Postgraduate Medical Education? Opening the Black Box Using the Framework of Four Narrative Profiles for Consultation Performance
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Context
Four narrative profiles were previously developed as an evidence-informed framework for reflection and feedback on consultation performance in medical education. The profiles are grounded in four typologies mapped onto a conceptual framework, using the dimensions of doctor patient interaction (DPI) and medical expertise (ME) to classify overall performance.
Objective
Content validation of the narrative profiles derived from routine clinical consultations to inform a developmental roadmap for patient-centred consulting.
Methods
A qualitative study was performed in Family Medicine (FM) residency training, in which 11 first year and 7 third year FM trainees participated. The same FM assessor (n=11) observed a series of encounters of the trainee every three months during their training year, after which recurrent behaviours were described in a feedback report and overall consultation performance classified in one of the four typologies. Feedback reports (n=56) were categorised for each typology, coded on recurrent behaviours and then compared with the concordant narrative profile content.
Results
We identified overlapping recurrent behaviours and communication themes between the narrative profiles and feedback reports. For typology 1 (DPI+, ME-), the communication approach shows natural alignment with the patient, more exploration of patient concerns is needed, and the treatment plan needs connection to the reasons for consulting. In typology 2, active listening provides room for patient experience, yet patient centredness risks losing focus, while exploring of reasons for consulting is present. Inadequate responses to patient cues and losing structure in the consultation for typology 3, result in not grounding reassurance in clinical findings. For typology 4, curiosity towards patient’s concerns, may support understanding of symptoms and expectations.
Conclusion
A developmental road map for patient centred consulting was outlined, covering balancing medical tasks with exploring patient cues, enacting leadership in agenda management and integrating medical expertise in applied communication, providing focus and language for individual learning trajectories.
