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Title: The art and science of patient centred practice : what do medical students learn from talking with and about patients?
Author: Williams , Lynsey
ISNI:       0000 0004 6423 8990
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2017
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Medical student communication with patients has been subject to scrutiny from educators and policy makers. Recommendations that treat medical student-patient talk as known and understandable have formed the basis for communication improvement. The aim of this thesis was to understand how undergraduate medical students talk with and about patients in the course of learning to communicate effectively and develop their clinical skills and knowledge. Following a review of the literature, a research question was developed to investigate how the information and experiences shared between student and patient in one encounter might shape, and be shaped by organisational tasks and goals. Data was collected at a large teaching hospital in the South West of the UK. Video recordings were made of medical student-patient clerking and patient case presentations involving 19 students, 34 patients and 9 clinical tutors. Paired recordings - where the same patients were clerked and presented to clinical tutors in assessed case presentations - were captured on 13 occasions. The resulting data was transcribed and analysed using conversation analytic methods (CA). It was found that in student-patient clerking encounters, features particular to the students’ ‘learning’ or ‘novice’ status were influential in communication with patients. In the case presentation; students were found to orient strongly to the educative assessment imperative. A comparative analysis of the paired data revealed specific stages of the case presentation exhibiting particular uses of patient talk from the prior clerking; demonstrated in transformation of ‘reused’ patient talk, This suggested a strong relationship between talk with and talk about the patient, and the management of this by medical students to demonstrate adherence to the imperative of medical education. This study uniquely offers a systematic comparative analysis of talk across these two learning encounters. The influence of assessment-driven learning on student talk with patients can be demonstrated in and through this analysis; detracting medical students from an opportunity for experiential learning. In understanding the relationship between these learning opportunities what students are actually taking away from patient encounters, as well as the role of patients as educators is clarified. Understanding and critical awareness of this by all parties may lead to a reimagining of the learning potential of these talk events.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available