Advances in Health Sciences Education

, Volume 24, Issue 1, pp 15–32 | Cite as

Patient-centred education: How do learners’ perceptions change as they experience clinical training?

  • Shannon FongEmail author
  • Amy Tan
  • Joanna Czupryn
  • Anna Oswald


The use of patient educators is one of many teaching strategies meant to foster principles of patient-centred care. We previously found that early patient educator exposure helped to shape the understanding of patient-centredness in pre-clerkship learners. We now expand on this work to evaluate whether there is persistence of initial perceptions and to explore general reflections on longer-term impacts of early patient educator exposures once learners are immersed in the clinical phase of their training. In this follow-up study, we conducted group interviews with a sample of learners who wrote reflections as part of their pre-clerkship patient educator experience. We explored how perspectives on patient educators changed over time, and determined which themes identified during pre-clerkship remained relevant to clinical trainees. Audio recordings were transcribed and analyzed thematically using a hybrid inductive and deductive analysis to construct a thematic framework derived through a method of constant comparison. We identified three new themes: “value of early clinical experience”, “change in learners’ perspectives”, and “valuing and applying CanMEDS roles other than Medical Expert”. Themes from pre-clerkship that remained relevant included: “patients’ perspective humanizes disease”, “patients’ experiences with navigating the healthcare system”, “learners’ perceptions of the learning strategy”, and “inaccuracies and inconsistencies in the learning experience.” Many themes identified in pre-clerkship learners remain relevant in early clinical trainees. Further, insights from pre-clerkship experiences with patient educators evolve as learners experience clerkship with definite shifts in emphasis and new perspectives. This work illuminates the utility of patient educators for those considering this strategy for supporting the development of patient-centredness in undergraduate medical education.


Identify formation Patient-centredness Patient educators Qualitative Undergraduate medical education 



Ethics was approved by University of Alberta Health Research Ethics Office. SF reviewed all the primary data, co-created and revised the thematic frameworks and drafted and edited the manuscript. AT co-conceived the research question and design, reviewed and analyzed the primary data, co-created and revised the thematic frameworks and edited the manuscript. JC collected and reviewed all the primary data, co-created and revised the thematic frameworks and edited the manuscript. AO co-conceived the research question and design, reviewed the primary data, co-created and revised the thematic frameworks and edited the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.


  1. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NH: Prentice Hall.Google Scholar
  2. Barley, G. E., Fisher, J., Dwinnell, B., & White, K. (2006). Teaching foundational physical examination skills: Study results comparing lay teaching associates and physician instructors. Academic Medicine, 81(10), S95–S97.CrossRefGoogle Scholar
  3. Barr, J., Bull, R., & Rooney, K. (2015). Developing a patient focussed professional identity: An exploratory investigation of medical students’ encounters with patient partnership in learning. Advances in Health Sciences Education, 20(2), 325–338.CrossRefGoogle Scholar
  4. Barr, J., Ogden, K., & Rooney, K. (2014). Committing to patient-centred medical education. The Clinical Teacher, 11(7), 503–506.CrossRefGoogle Scholar
  5. Bechel, D. L., Myers, W. A., & Smith, D. G. (2000). Does patient-centered care pay off? The Joint Commission Journal on Quality Improvement, 26(7), 400–409.CrossRefGoogle Scholar
  6. Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36, 391–409.CrossRefGoogle Scholar
  7. Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage.Google Scholar
  8. Cook, D. A., & West, C. P. (2013). Perspective: Reconsidering the focus on “outcomes research” in medical education: A cautionary note. Academic Medicine, 88(2), 162–167.CrossRefGoogle Scholar
  9. Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches (4th ed.). Thousand Oaks, CA: Sage.Google Scholar
  10. Delaney, L. J. (2017). Patient-centred care as an approach to improving health care in Australia. Collegian, 25(1), 119–123.CrossRefGoogle Scholar
  11. Diemers, A. D., Dolmans, D. H., Verwijnen, M. G., Heineman, E., & Scherpbier, A. J. (2008). Students’ opinions about the effects of preclinical patient contacts on their learning. Advances in Health Sciences Education, 13(5), 633–647.CrossRefGoogle Scholar
  12. Duffy, J. M., Chequer, S., Braddy, A., Mylan, S., Royuela, A., Zamora, J., et al. (2016). Educational effectiveness of gynaecological teaching associates: A multicentre randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 123(6), 1005–1010.CrossRefGoogle Scholar
  13. Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care. The Annals of Family Medicine, 9(2), 100–103.CrossRefGoogle Scholar
  14. Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1), 80–92.CrossRefGoogle Scholar
  15. Frank, J. R., Snell, L., & Sherbino, J. (Eds.). (2015). CanMEDS 2015 physician competency framework. Ottawa: Royal College of Physicians and Surgeons of Canada.Google Scholar
  16. Gaufberg, E. H., Batalden, M., Sands, R., & Bell, S. K. (2010). The hidden curriculum: What can we learn from third-year medical student narrative reflections? Academic Medicine, 85(11), 1709–1716.CrossRefGoogle Scholar
  17. Grankvist, O., Olofsson, A. D., & Isaksson, R. (2014). Can physicians be replaced with gynecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden. Patient Education and Counseling, 96(1), 50–54.CrossRefGoogle Scholar
  18. Gruppen, L. D., Branch, V. K., & Laing, T. J. (1996). The use of trained patient educators with rheumatoid arthritis to teach medical students. Arthritis & Rheumatology, 9(4), 302–308.CrossRefGoogle Scholar
  19. Hojat, M., Mangione, S., Nasca, T. J., Gonnella, J. S., & Magee, M. (2005). Empathy scores in medical school and ratings of empathic behavior in residency training 3 years later. The Journal of Social Psychology, 145(6), 663–672.CrossRefGoogle Scholar
  20. Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., et al. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191.CrossRefGoogle Scholar
  21. Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
  22. Jackson, A., Blaxter, L., & Lewando-Hundt, G. (2003). Participating in medical education: Views of patients and carers living in deprived communities. Medical Education, 37(6), 532–538.CrossRefGoogle Scholar
  23. Jha, V., Quinton, N. D., Bekker, H. L., & Roberts, T. E. (2009). Strategies and interventions for the involvement of real patients in medical education: A systematic review. Medical Education, 43(1), 10–20.CrossRefGoogle Scholar
  24. Kleinman, D. E., Hage, M. L., Hoole, A. J., & Kowlowitz, V. (1996). Pelvic examination instruction and experience: A comparison of laywoman-trained and physician-trained students. Academic Medicine, 71(11), 1239–1243.CrossRefGoogle Scholar
  25. Lauckner, H., Doucet, S., & Wells, S. (2012). Patients as educators: The challenges and benefits of sharing experiences with students. Medical Education, 46(10), 992–1000.CrossRefGoogle Scholar
  26. Neumann, M., Edelhuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., et al. (2011). Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine, 86(8), 996–1009.CrossRefGoogle Scholar
  27. Oswald, A., Czupryn, J., Wiseman, J., & Snell, L. (2014). Patient-centred education: What do students think? Medical Education, 48(2), 170–180.CrossRefGoogle Scholar
  28. Oswald, A. E., Wiseman, J., Bell, M. J., & Snell, L. (2011). Musculoskeletal examination teaching by patients versus physicians: How are they different? Neither better nor worse, but complementary. Medical Teacher, 33(5), e227–e235.CrossRefGoogle Scholar
  29. Perrig, M., Berendonk, C., Rogausch, A., & Beyeler, C. (2016). Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills—A controlled study. BMC Medical Education, 16(1), 35.CrossRefGoogle Scholar
  30. Peyton, J. R. (1998). Teaching and learning in medical practice. Rickmansworth, UK: Manticore Europe Ltd.Google Scholar
  31. Pickard, S., Baraitser, P., Rymer, J., & Piper, J. (2003). Can gynaecology teaching associates provide high quality effective training for medical students in the United Kingdom? Comparative study. BMJ, 327(7428), 1389–1392.CrossRefGoogle Scholar
  32. Rao, J. K., Weinberger, M., & Kroenke, K. (2000). Visit-specific expectations and patient-centered outcomes: A literature review. Archives of Family Medicine, 9(10), 1148–1155.CrossRefGoogle Scholar
  33. Satterfield, J. M., & Hughes, E. (2007). Emotion skills training for medical students: A systematic review. Medical Education, 41(10), 935–941.CrossRefGoogle Scholar
  34. Soo, J., Brett-MacLean, P., Cave, M., & Oswald, A. (2016). At the precipice: A prospective exploration of medical students’ expectations of the pre-clerkship to clerkship transition. Advances in Health Sciences Education, 21(1), 141–162.CrossRefGoogle Scholar
  35. Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., et al. (2000). The impact of patient-centered care on outcomes. The Journal of Family Practice, 49(9), 796–804.Google Scholar
  36. Tamblyn, R., Abrahamowicz, M., Dauphinee, D., Wenghofer, E., Jacques, A., Klass, D., et al. (2007). Physician scores on a national clinical skills examination as predictors of complaints to medical regulatory authorities. JAMA, 298(9), 993–1001.CrossRefGoogle Scholar
  37. Towle, A., Bainbridge, L., Godolphin, W., Katz, A., Kline, C., Lown, B., et al. (2010). Active patient involvement in the education of health professionals. Medical Education, 44(1), 64–74.CrossRefGoogle Scholar
  38. Vygotsky, L. S. (1980). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.Google Scholar
  39. Windish, D. M., Price, E. G., Clever, S. L., Magaziner, J. L., & Thomas, P. A. (2005). Teaching medical students the important connection between communication and clinical reasoning. Journal of General Internal Medicine, 20(12), 1108–1113.CrossRefGoogle Scholar
  40. Wykurz, G., & Kelly, D. (2002). Developing the role of patients as teachers: Literature review. BMJ, 325(7368), 818–821.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.University of AlbertaEdmontonCanada
  2. 2.Department of Family MedicineUniversity of CalgaryCalgaryCanada
  3. 3.Department of MedicineUniversity of AlbertaEdmontonCanada

Personalised recommendations