Patients as partners in the development of medical students' professional identity

Purpose: The purpose of this study is to develop understanding about the processes involved in building a patient-centred professional identity in the senior medical student years. Becoming a doctor demands a sophisticated understanding that extends beyond scientific knowledge. Patient encounters are central to providing opportunities for medical students to 'learn their craft'. This process, while starting in the undergraduate years, continues through to the junior doctor role. Whether medical students consider patients and 'learning their craft' to be a central combination that is welcomed or expected throughout their undergraduate training is to be explored in this study. This examination of students' development concentrates on discovering the ways in which partnering with patients in undergraduate learning impacts on their professional identity formation. The mechanism of a university patient-centred teaching program provides an ideal basis for enquiry into students' learning and development, in the way they become doctors and their views on how patients are related to this journey. Background: A rapidly changing health landscape in Australia is affecting medical students entering the health workforce as junior doctors. The key areas of higher education reform, health system reform, community expectations and engagement are all determinants of the way in which medical students are being required to learn their craft. Medical education must generate medical professionals who are capable of responding to these and other changes they will face. Patient-centredness and partnerships with patients are terms which are commonly used now in this new health care climate. However in the education of health professionals there remains a void of understanding about how students actually learn this and assimilate it into their developing doctor identity. A teaching and learning program, the Patient Partner Program (P3), attempts to teach a patient-centred approach. It is of interest for medical educators to determine the meaning and significance of such a contribution to learning in respect to students' growth towards becoming doctors, the construction of meaning from these learning encounters and future capacity to provide patient-centred care within the contemporary health system. Methods: An exploratory interpretive research design was used to conduct this study. It employed three qualitative data collection methods: (i) Focus groups (ii) Extended response questionnaire and (iii) Semi-structured interviews. Data was coded and analysed thematically. Findings: The findings indicate that the professional identity of medical students begins to form prior to entry into the MBBS and is then constructed along traditional lines in the preclinical years. P3 offers a disruption to this development by way of an intersection with patients with chronic illness which potentially allows meaningful construction. This point of reflection provides an opportunity to engage at a higher level in medical identity development. Conclusion: Throughout the journey of becoming a doctor medical educators need to equip students with capabilities in negotiating the field of conflict that is present when learning with and around patients. The findings discussed in this thesis further stimulate the patient-centred agenda by understanding the student‚Äö-patient nexus in medical education and its potential for building a patient-centred professional identity.