Learning patient-centredness with simulated/standardized patients: A realist review: BEME Guide No. 68

Abstract

Background

Given the positive outcomes of patient-centred care on health outcomes, future doctors should learn how to deliver patient-centred care. The literature describes a wide variety of educational interventions with standardized patients (SPs) that focus on learning patient-centredness. However, it is unclear which mechanisms are responsible for learning patient-centredness when applying educational interventions with SPs.

Objective

This study aims to clarify how healthcare learners and professionals learn patient-centredness through interventions involving SPs in different healthcare educational contexts.

Methods

A realist approach was used to focus on what works, for whom, in what circumstances, in what respect and why. Databases were searched through 2019. Nineteen papers were included for analysis. Through inductive and deductive coding, CIC’MO configurations were identified to build partial program theories. These CIC’MOs describe how Interventions with SPs change the Context (C→C’) such that Mechanisms (M) are triggered that are expected to foster patient-centredness as Outcome.

Results

Interventions with SPs create three contexts which are ‘a safe learning environment,’ ‘reflective practice,’ and ‘enabling people to learn together.’ These contexts trigger the following seven mechanisms: feeling confident, feeling a sense of comfort, feeling safe, self-reflection, awareness, comparing & contrasting perspectives, combining and broadening perspectives. A tentative final program theory with mechanisms belonging to three main learning components (cognitive, regulative metacognitive and affective) is proposed: Interventions with SPs create a safe learning environment (C’) in which learners gain feelings of confidence, comfort and safety (affective M). This safe learning environment enables two other mutual related contexts in which learners learn together (C’), through comparing & contrasting, combining and broadening their perspectives (cognitive M) and in which reflective practice (C’) facilitates self-reflection and awareness (metacognitive M) in order to learn patient-centeredness.

Conclusion

These insights offer educators ways to deliberately use interventions with SPs that trigger the described mechanisms for learning patient-centredness.

Keywords:

• Patient-centredness
• healthcare professionals
• healthcare learners
• educational intervention
• realist review
• simulated patients
• standardized patients

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Christel Grau Canét-Wittkampf

Christel Grau Canét-Wittkampf, MD, MSc, is a general practitioner and assistant professor in general practice and researcher, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Agnes Diemers

Agnes Diemers, MD, PhD, works as Head of Faculty Development at the University Medical Center Groningen. She is an experienced teacher and educationalist with expertise in Health Professions Education and Faculty development. As an assistant professor, she has expertise in qualitative research in research on learning from patients and on the learning environment of Health Professions Education.

Kristin Van den Bogerd

Kristin Van den Bogerd, Msc, is clinical psychologist and communication skills trainer at the skills lab of the medical school of the University of Antwerp, Department of Primary and Interdisciplinary Care, Belgium. She has been teaching and organizing communication skills education in Antwerp for the past 13 years.

Johanna Schönrock-Adema

Johanna Schönrock-Adema, PhD, is a psychologist and researcher at the Center for Educational Development and Research in health sciences and the Lifelong Learning, Education & Assessment Research Network (LEARN), University of Groningen and University Medical Center Groningen, The Netherlands.

Roger Damoiseaux

Roger Damoiseaux, MD, PhD, is a Professor in General Practice at the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. His research focuses upon education in evidence based medicine and interprofessional collaboration.

Dorien Zwart

Dorien Zwart, MD, PhD, is a general practitioner and associate professor at the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Here, she is head of department of general practice and researcher in quality and safety in the health care continuum.

Debbie Jaarsma

Debbie Jaarsma, DVM, PhD, is professor innovation and research in medical education, University Medical Center Groningen, University of Groningen, the Netherlands. And she is Dean at the Faculty of Veterinary Medicine, Utrecht University, the Netherlands.

Saskia Mol

Saskia Mol, MD, PhD, is associate professor of medical education, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. She was a consultant in the implementation process of a patient panel within the medical curriculum.

Katrien Bombeke

Katrien Bombeke, MD, PhD, is general practitioner and lecturer in communication skills at the skills lab of the medical school of the University of Antwerp, Department of Primary and Interdisciplinary Care, Belgium. She has a special interest in educational research in the domain of patient-centredness and qualitative research methods.

Esther de Groot

Esther de Groot, PhD, is assistant professor in the learning sciences, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Her research interest is in (interprofessional) workplace learning of the three elements of EBM: patients, clinicians and evidence.