Abstract
ABSTRACTIssue: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore. Evidence: There is increasing evidence that practitioners' relational skills, such as empathy and reflection, improve patients' health outcomes. Efforts to shift education toward patient-centered care in interprofessional teams have been made at the professional level, most notably in medical schools. However, reform must begin at the preprofessional level, to start cultivation of the habits that support humane care as early as possible and protect against empathic decline and the development of counterproductive attitudes to collaboration. The conceptual basis for reform is offered by relationship-centered care (RCC), a framework that goes beyond patient-centered care and interprofessional teamwork to focus on the reciprocal human interactions at the micro, mezzo, and macro levels of care. RCC identifies practitioners' relationships with patients, colleagues, community, and self as the critical interpersonal dimensions of healthcare and describes a foundation of values, knowledge, and skills required for teaching each dimension. The teaching of these foundations can be facilitated with techniques from narrative medicine, a compatible care model that conceptualizes health care as a context in which humans exchange stories and thus require narrative competence. Implications: We suggest beginning the educational reform at the preprofessional level with the implementation of a formal curriculum based on the 4 RCC dimensions with students expected to gain beginner levels of competency on these dimensions in addition to evidence-based principles of health sciences. This requires interprofessional collaboration among health professions, social science, and liberal arts faculty and training of health professions faculty in narrative medicine. Next, we suggest engaging in incremental change in the organizational culture with professional development and team-building activities. Although we need systematic research on the efficacy of the components of the transformation, their impact on students' learning, and their costs, it is important to engage in efforts to prepare professionals who are able to respond to the complex health needs of individuals and society in the 21st century.
Highlights
A patient recently shared that when he was diagnosed with prostate cancer at a highly advanced cancer center, he was told that its severity rated 9 on a 10-point (Gleason) scale
Institute of Medicine (IOM) called for education that shifts focus from exclusive mastery of technical skills to the teaching of the human dimensions of care and developing students’ ability to provide patient-centered care in interprofessional teams
Whereas McNair[18] suggested the value-based professionalism framework as a way to prepare preprofessional students for humane care, we argue for a broader framework that rests on a bio-psycho-social-cultural perspective. This claim is bolstered by the recent (2015) inclusion of a section on the psychological, social, and biological foundations of behavior in the Medical College Admissions Test to “communicate the need for future physicians to be prepared to deal with the human and social issues of medicine.”19(p1) We suggest reforming preprofessional education with relationship-centered care (RCC), a framework that identifies the critical relationships and competencies involved in effective and humane care.[20,21]
Summary
A patient recently shared that when he was diagnosed with prostate cancer at a highly advanced cancer center, he was told that its severity rated 9 on a 10-point (Gleason) scale. Narrative medicine suggests that we need to teach students about the importance of the practitioner–community narrative situation and the relationship between medical practitioners and society at large.[22] Practitioners need to engage in open and honest conversations with society about what constitutes optimal care and what kind of medical system is desirable Education for this RCC dimension requires socializing students to believe that advocacy for change in patients’ social and physical environments is a powerful health care tool and that community integrity and leadership are critical for equitable health policy and availability of services.[25] Students need knowledge about communities as dynamic systems affected by economic, social, and political forces so that they can understand that when processes such as gentrification take place, poorer members experience high levels of stress and their health is threatened. The stage of reform is the transformation of the context of learning, the informal curriculum,
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
