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Phenomenon : Patient-centered communication is an ideal for undergraduate medical education and has been for decades. However, medical students often find the patient-centered approach challenging. The present study finds a possible discordance between formal intentions of a medical curriculum and the corresponding learning environment. The objective of our study was to explore how medical curriculum resonates with the purpose of patient-centered medicine, including how a possible dynamic may have helped maintain this discordance in undergraduate medical education. Approach : The study took a qualitative approach exploring the medical curriculum via a structured communication course. The educational context for the course was considered a discursive environment, partially constructed through documents. The concept of textual agency was used to analyze curriculum and course documents. This was to explore how competencies were presented in the medical curriculum and course descriptions and how they were translated through the practices of the communication course. Inductive thematic analysis was used to analyze observations made during the course. Findings : Our analysis suggested that the medical curriculum content and structure still emphasize bio-medical disciplines and knowledge domains in students learning. This connected well with the socialization of medical students toward the role as medical experts whose primary task is to provide information, while patients are defined as passive subjects, who received information. The course description also operationalized complexities of patient-centered communication to a measurable, instrumental structure of skills. This focus on one-directional communication frames the students' understanding of the courses and their performance in it. They learn that: (1) meeting a real patient is a rare opportunity, (2) engaging patients' thoughts and feelings in the conversation is challenging, and (3) the biomedical aspect should be prioritized in the conversation. Insights : These findings suggested that the medical curriculum we studied gave limited room for patient-centered medicine, even in communication training. The power of macro-level documents framed and focused micro-level learning activities and could help explain observed disharmonies in patient-medical student encounters. We see how patient-centered medicine - in both texts and practice - is represented and enacted as a peripheral activity and patients are given a marginal position in encounters with students. The findings suggested that there are challenges for progress and change toward a more patient-centered communication training and curriculum. However, empirical findings also offered points of departure for course leaders and curriculum planners wishing to take steps toward a stronger and more reflective patient-centered approach in medical education, supported through the document structure and the translation of the curriculum through relevant learning activities.

Objectives: To explore what patients with chronic conditions emphasize as important in the patient-medical student conversation, and how the patients' experiences relate to trust., Methods: Twenty-one video-recorded sessions of patients' feedback in simulation-based communication courses for medical students were observed, transcribed, analyzed inductively and organized into three themes., Results: In the patients' feedback, three aspects were emphasized as important relating to trust: a) when the medical student relates medical information to the patient's lifeworld, b) when the student leads the patient throughout the conversation, and c) when the patient gets emotional support from the student. The patients felt that being met this way by the students grows trust and allows them to lean into the uncertainties they experience while still feeling safe., Discussion: The patients emphasize three aspects of importance in conversations with the medical students that grow trust. We argue that these aspects cannot be found in the traditional authority-led practice but can be found in leadership, which imply empathy and willingness to learn from patients. We suggest that students should learn that to effectively communicate with patients infers such leadership. By doing so, medical students can walk alongside their patients to build a relationship and nurture trust., Competing Interests: Declaration of conflicting interestsThe first author was an employee at CAMES when the present research was conducted.

Introduction: During a health crisis, hospitals must prioritise activities and resources, which can compromise clerkship-based learning. We explored how health crises affect clinical clerkships using the COVID-19 pandemic as an example., Methods: In a constructivist qualitative study, we conducted 22 semi-structured interviews with key stakeholders (i.e. medical students and doctors) from two teaching hospitals and 10 different departments. We used thematic analysis to investigate our data and used stakeholder theory as a sensitising concept., Results: We identified three themes: (1) emotional triggers and reactions; (2) negotiation of legitimacy; and (3) building resilience. Our results suggest that the health crisis accentuated already existing problems in clerkships, such as students' feelings of low legitimacy, constant negotiation of roles, inconsistencies navigating rules and regulations and low levels of active participation. Medical students and doctors adapted to the new organisational demands by developing increased resilience. Students responded by reaching out for guidance and acceptance to remain relevant in the clinical clerkships. Doctors developed a behaviour of closing in and focused on managing themselves and their patients. This created tension between these two stakeholder groups., Conclusion: A health crisis can critically disrupt the hierarchical structure within the clinical clerkships and exacerbate existing conflicts between stakeholder groups. When medical students are not perceived as legitimate stakeholders in clinical clerkships during a health crisis, their attendance is perceived as unnecessary or even a nuisance. Despite increased student proactiveness and resilience, their roles inevitably shift from being doctors-to-be to students-to-be-managed., (© 2022 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objective: To explore what and how medical students learn from patients with chronic conditions in the context of communication skills training., Methods: Semi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes., Results: Learning from patients provided medical students opportunities to see the world through the patients' eyes, understand the diversity of patients' needs, and recognize the importance of matching patients' and doctors' perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients., Conclusion: The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the 'doctor as person' in medical education., Practice Implications: Patients with chronic conditions strengthen students' learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships., Methods: In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework., Results: We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care., Conclusion: Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale., (© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Objectives: To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry., Methods: This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training., Results: A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t (97) =2.38, p= 0.02, but no changes in attitudes t (98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes., Conclusions: Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.

Objectives: The aim of this study was to explore medical students' learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students' perceptions of psychiatric patients and students' reflections on meeting and communicating with psychiatric patients., Methods: The authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews., Results: Students taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients., Conclusion: The format of patient cases included in teaching may have a substantial impact on students' patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

Early identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4-1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor's judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers' informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.

Background: Reflection, the ability to examine critically one's own learning and functioning, is considered important for 'the good doctor'. The Groningen Reflection Ability Scale (GRAS) is an instrument measuring student reflection, which has not yet been validated beyond the original Dutch study. The aim of this study was to adapt GRAS for use in a Danish setting and to investigate the psychometric properties of GRAS-DK., Methods: We performed a cross-cultural adaptation of GRAS from Dutch to Danish. Next, we collected primary data online, performed a retest, analysed data descriptively, estimated measurement error, performed an exploratory and a confirmatory factor analysis to test the proposed three-factor structure., Results: 361 (69%) of 523 invited students completed GRAS-DK. Their mean score was 88 (SD = 11.42; scale maximum 115). Scores were approximately normally distributed. Measurement error and test-retest score differences were acceptable, apart from a few extreme outliers. However, the confirmatory factor analysis did not replicate the original three-factor model and neither could a one-dimensional structure be confirmed., Conclusions: GRAS is already in use, however we advise that use of GRAS-DK for effect measurements and group comparison awaits further review and validation studies. Our negative finding might be explained by a weak conceptualisation of personal reflection.