At a recent medical education conference, I was chatting between sessions with another educator. We were discussing competency-based medical education and its learner-centered focus. He told me he considered learner-centeredness key to being truly patient-centered because our learners will be caring for patients. Ensuring their competency means better care for patients. I agreed with his premise and began to consider that learner-centeredness may have significant parallels with patient-centeredness.
For me, patient-centeredness helps to focus my clinical practice around eliciting patient values and engaging in shared decision making. Sitting in the patient seat myself, then as a parent, and as a caregiver of my aging father, has further cemented the importance of emotional support, checking in on patient understanding, and having a shared vision on our goals. Being sick is hard and often isolating, yet everyday patients are faced with navigating an impossible health care labyrinth while ill, in pain, and alone. As a physician, providing excellent care necessitates partnering with patients where they are and working through the journey together. I see these parallels as an educator.
Training in health care is hard and often isolating. Accrediting bodies dictate not just what must be learned but often how it should be learned. Long checklists of rotational requirements and high-stakes exams have long been the focus. For a small subset of learners, these well-defined paths lead to success. But for many others, often those in minoritized groups or those who have taken less traditional journeys, these narrow paths can create potential barriers.
Patient centered-care seeks to reduce health inequities and mitigate negative experiences associated with interactions in the health care system, while promoting improved patient outcomes and satisfaction. Similarly, learner-centered education focuses on addressing the individual needs of learners by building on their strengths and addressing challenges. Patient-centered care fosters a partnership between patients and providers, a principle mirrored in learner-centered education, which emphasizes systems that value the co-production of learning. Just as physicians collaborate with patients in a patient-centered model, medical educators can partner with learners, working together to achieve mutually defined educational goals. A learner centered approach can help focus educators on the individual needs of learners by maximizing strengths and addressing challenges. The former sought to create a partnership between patients and their providers which the latter emulates in developing systems valuing the co-production of learning. Just as physicians partner with patients in a patient centered model, medical educators can partner with learners to work together in a shared presence to attain mutually agreed upon educational goals.
How can educators support the development of patient-centered physicians?
Teaching encounters vary from short clinical experiences where the learner may rotate with a supervising clinician for only one or two sessions to more longitudinal encounters with repeated opportunities for engagement and learning. Regardless of the length of time we are with our learners, we share a responsibility in training them. Borrowing from patient-centered care, we can center on our learners by checking in, assessing understanding, framing progress, consolidating teaching points, and checking out.
Checking in with learners personalizes the student encounter. Even in short clinical experiences, taking a few minutes to ask where a learner is in their journey and understanding how this clinical experience fits in that trajectory puts the student at the heart of the learning. As a third-year medical student hoping to go into family medicine during my surgery rotation, I spent a week on the urology service. On the first day, the attending urologist asked about my future. When he learned I planned to go into family medicine, he offered me the chance to spend most of the rotation in the urology clinic instead of the operating room. He made that clinical experience relevant to my learning goals even though I did not intend to be a urologist.
Learners come to us with varying levels of medical knowledge and clinical skills. When I have a new medical student, it may be their first or their tenth rotation. Their individual lived experiences influences their learning attitudes and potential learning barriers. Assessing this starting point during a check in provides a clearer orientation for the teacher to individualize the learning to best benefit the learner. Knowing a student has never held a speculum, for example, allows me to tailor the learning experience in a way that bolsters rather than frustrates.
Understanding the starting point also allows teachers to establish reasonable expectations around progress. While this will be influenced by the time to be spent and the expected continuity with the student, all students deserve some co-production in their learning. This co-production does not substitute for stated learning objectives, rather it allows students a chance to understand how these learning objectives relate to the overall end goal of competence. Compassionate patient communication, solid medical knowledge, clinical reasoning, and working in teams transcends all practice types and can always be a focus for progress in addition to relevant specialty-specific components of a rotation.
Engaging students in methods to assess comprehension, such as teach back or other similar modalities with a lens on why these components matters in the context of their personal educational journey or in the framework of expected progress previously discussed. Active learning supports the development of critical thinking skills and learning to understand instead of just to regurgitate buzz words. When deficiencies exist, empower students to self-assess and normalize recognizing and addressing gaps through learning plans. Especially in student-teacher relationships with some continuity, supporting learners in the inevitable highs and lows, much like we support patients, will help support long term success.
Educators who take the time to support reflective feedback conversations, connect current learning and clinical progress to a learners’s educational and career goals build trust and motivation with learners. Akin to a patient centered approach emphasizing trust and motivation based in a partnership towards shared goals, the learner centered model emphasizes an individualized experience geared at meeting students where they are and guiding them with expertise and wisdom towards competence and compassion. The return on investment for taking the time now is a stronger health care force caring for patients.
KrisEmily McCrory
