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“他们是我的支持者”:一项探索医学生纵向关系和患者健康的定性研究。

"They were an advocate for me": A Qualitative Study Exploring Medical Student Longitudinal Relationships and Patient Well-Being.

机构信息

Department of General Surgery, University of New Mexico, Albuquerque, NM, USA.

MSC10 5610, 1 University of New Mexico, Albuquerque, NM, 87131, USA.

出版信息

J Gen Intern Med. 2023 Feb;38(3):648-652. doi: 10.1007/s11606-022-07773-1. Epub 2022 Sep 9.

Abstract

BACKGROUND

Patient navigators, community health workers, and care management teams improve patient experience and health outcomes. Medical student involvement in these roles is limited. Evaluation of these programs focuses on the student experience with less attention to patient participants.

OBJECTIVES

We sought (1) to understand the experience of being a participant in a medical education program; (2) to explore the patient-medical student relationship; and (3) to describe the impact of this relationship on patient health and well-being.

DESIGN

This was a qualitative study that utilized in-depth semi-structured interviews.

PARTICIPANTS

Participants were selected based on enrollment in a preceptorship program at an urban academic medical center between 2017 and 2020. Participants worked with a medical student during an 18-month period in which the medical student was embedded in a primary care medical home, serving as a health systems navigator for 1-2 medically and socially complex patients.

APPROACH

Nine participants completed 1-h compensated phone interviews. This study was deemed IRB exempt.

KEY RESULTS

Three themes and eight subthemes were identified, including Navigators Were Key to Accessing the System, Interpersonal Partnerships Improved Health, and Fulfillment in Teaching of Lived Experience. Navigators eased the burden of chronic illness by being a point of contact in the health system, which improved participants' overall experience. Participants also described the relationship as therapeutic, citing improvement and stability in both mental and physical health. Lastly, participants found meaning in chronic illness by teaching their students empathy.

CONCLUSIONS

Longitudinal patient-medical student relationships may provide stability and health benefits. These partnerships have the possibility of adding value to patients' healthcare experiences. This study complements current literature highlighting the value of these relationships for pre-clinical medical students. As such, additional opportunities for and additional research regarding the value of longitudinal patient connection should be incorporated in undergraduate medical education.

摘要

背景

患者导航员、社区卫生工作者和护理管理团队改善了患者体验和健康结果。医学生参与这些角色的机会有限。这些项目的评估侧重于学生的体验,而对患者参与者的关注较少。

目的

我们旨在(1)了解参与医学教育项目的体验;(2)探讨医患关系;(3)描述这种关系对患者健康和福祉的影响。

设计

这是一项定性研究,采用深入的半结构化访谈。

参与者

参与者是根据 2017 年至 2020 年在城市学术医疗中心参加导师计划的情况入选的。参与者与一名医学生合作,为期 18 个月,在此期间,医学生被嵌入初级保健医疗之家,作为 1-2 名医疗和社会复杂患者的健康系统导航员。

方法

9 名参与者完成了 1 小时的有偿电话访谈。本研究被认为是 IRB 豁免的。

主要结果

确定了三个主题和八个子主题,包括导航员是进入系统的关键、人际伙伴关系改善健康以及教学中体现生活经验。导航员作为医疗系统中的联系人,减轻了慢性病的负担,改善了参与者的整体体验。参与者还描述了这种关系具有治疗作用,称他们的身心健康都有所改善和稳定。最后,参与者通过教授学生同理心,从慢性疾病中找到了意义。

结论

长期的医患关系可能会提供稳定性和健康益处。这些伙伴关系有可能为患者的医疗体验增加价值。这项研究补充了目前强调这些关系对临床前医学生价值的文献。因此,应该在本科医学教育中增加对长期患者联系的机会和研究。

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