Kostov Camille E, Rees Charlotte E, Gormley Gerard J, Monrouxe Lynn V
Salisbury District Hospital, Salisbury, UK.
Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Melbourne, Victoria, Australia.
BMJ Open. 2018 Jan 21;8(1):e017738. doi: 10.1136/bmjopen-2017-017738.
For many years, the voice of patients has been understood as a critical element for the improvement of care quality in healthcare settings. How well medical graduates are prepared for clinical practice is an important question, but one that has rarely been considered from patient and public perspectives. We aimed to fill this gap by exploring patients and carers' experiences and expectations of junior doctors.
This comprises part of a wider study on UK medical graduates' preparedness for practice. A qualitative narrative methodology was used, comprising four individual and six group interviews.
25 patients and carers from three UK countries.
Data were transcribed, anonymised and analysed using framework analysis.
We identified three themes pertinent to answering our research question: (1) sources of knowledge (sources of information contributing to patients and carers' perceptions of junior doctors' impacting on expectations); (2) desires for student/trainee learning (experiences and expectations of medical training); and (3) future doctors (experiences and expectations of junior doctors). We also highlight metaphorical talk and humour, where relevant, in the quotes presented to give deeper insights into participants' perspectives of the issues. Participants focused on personal and interpersonal aspects of being a doctor, such as respect and communication. There was a strong assertion that medical graduates needed to gain direct experience with a diverse range of patients to encourage individualised care. Participants narrated their experiences of having symptoms ignored and attributed to an existing diagnosis ('diagnostic overshadowing') and problems relating to confidentiality.
Our findings support the view that patients and carers have clear expectations about junior doctors, and that patient views are important for preparing junior doctors for practice. There is a necessity for greater dialogue between patients, doctors and educators to clarify expectations and confidentiality issues around patient care.
多年来，患者的声音一直被视为改善医疗机构护理质量的关键要素。医学毕业生为临床实践做好准备的程度是一个重要问题，但很少从患者和公众的角度加以考虑。我们旨在通过探索患者及护理人员对初级医生的经历和期望来填补这一空白。
这是关于英国医学毕业生实践准备情况的一项更广泛研究的一部分。采用了定性叙事方法，包括四次个人访谈和六次小组访谈。
来自英国三个国家的25名患者及护理人员。
数据经转录、匿名处理后，采用框架分析法进行分析。
我们确定了与回答我们的研究问题相关的三个主题：（1）知识来源（有助于患者及护理人员形成对初级医生的认知并影响期望的信息来源）；（2）对学生/实习生学习的期望（医学培训的经历和期望）；（3）未来的医生（对初级医生的经历和期望）。我们还在呈现的引文中突出了相关的隐喻性表述和幽默，以便更深入地了解参与者对这些问题的看法。参与者关注成为一名医生的个人及人际方面，比如尊重和沟通。强烈主张医学毕业生需要获得与各类患者的直接接触经验，以鼓励个性化护理。参与者讲述了他们的症状被忽视并归因于现有诊断（“诊断遮蔽”）的经历以及与保密相关的问题。
我们的研究结果支持以下观点，即患者及护理人员对初级医生有着明确的期望，并且患者的观点对于让初级医生为临床实践做好准备很重要。患者、医生和教育工作者之间有必要进行更多对话，以厘清围绕患者护理的期望和保密问题。
