Abstract
BackgroundLongitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients’ perceptions of longitudinal relationships with the LIC students within Taiwan’s Confucian cultural and social context.MethodsWe invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients’ descriptions of their experiences interacting with the LIC students.ResultsTwenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients’ experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients’ experience, feelings, and mood.ConclusionIn our study, Taiwanese patients’ perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.
Highlights
Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts
We developed our study’s conceptual framework by considering the principle of educational continuity and the longitudinal relationships that underpin the LIC structure [6, 30]
The LIC students came from the medical school of the National Defense Medical Center (NDMC) located in Taipei, a city of 2.7 million inhabitants
Summary
Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. Education leaders create longitudinal integrated clerkships (LICs) to advance students’ clinical and scientific learning and support their professional identity formation [1,2,3,4,5]. The literature describes Western and East Asian conceptualizations of medical professionalism [19,20,21,22] In these contexts, patients’ experience of care relates to patients’ self-concepts and patterns of self-other relationships, that are primarily culturally determined [23]. In East Asia, cultural shifts and policies promote patient-centeredness, change has been slow [24] In this Confucian culture context, it remains unclear the degree to which cultural or institutional influences support or impede these changes [24]. The literature reports social contextual factors, including the health care system, government investment in healthcare, health insurance, and patient health literacy, impact patient experience of healthcare [28, 29]
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