Bezzina Cara, McQuade Robert, Lowe Wendy, Mair Frances, Pope Lindsey
General Practice and Primary Care, University of Glasgow, Glasgow, UK.
Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK.
Clin Teach. 2025 Feb;22(1):e70018. doi: 10.1111/tct.70018.
Multimorbidity and patient complexity are increasing, yet undergraduate medical education curricula remain dominated by single disease frameworks, where students are often shielded from exposure to this complexity. Why this shielding continues to occur is understandable; however, this may leave graduates feeling underprepared for real-world practice. This study aimed to explore medical students' experiences of encountering, managing and dealing with complexity and to provide informed recommendations for integrating complexity into clinical teaching.
Situated within a constructivist paradigm, this qualitative study involved focus groups (n = 4) with fourth- and fifth-year medical students (n = 17) from two Scottish Universities. Data were analysed using reflexive thematic analysis.
Learners in this study recognised multimorbidity, complex communication and emotionally charged interactions in their definitions of complexity. They described varying levels of exposure to complexity and opportunities to engage meaningfully with complex patients. Students felt that supervisors who shield students from learning opportunities with complex patients, together with a failing healthcare system, were critical limiting factors in their development. Learners emphasised the powerful role of supervisors in their learning experiences, which limited their ability to experiment and learn from productive failure but felt that with guided scaffolding and supervision, teaching and learning in this space could be meaningfully enhanced.
Exposure to and engagement with complex patients offer critical learning opportunities that may allow students to explore and better develop skills in managing complexity. With appropriate scaffolding, students can be empowered to embrace complexity in the clinical learning environment, potentially equipping them to care for complex patients.
多重疾病和患者复杂性日益增加，但本科医学教育课程仍以单一疾病框架为主导，学生在此框架下常常无法接触到这种复杂性。这种屏蔽现象持续存在的原因不难理解；然而，这可能会使毕业生感到对实际临床工作准备不足。本研究旨在探索医学生在遇到、管理和应对复杂性方面的经历，并为将复杂性融入临床教学提供有依据的建议。
本定性研究采用建构主义范式，对来自两所苏格兰大学的四年级和五年级医学生（共17名）进行了焦点小组访谈（共4组）。采用反思性主题分析法对数据进行分析。
本研究中的学习者在对复杂性的定义中认识到了多重疾病、复杂沟通和充满情感的互动。他们描述了接触复杂性的不同程度以及与复杂患者进行有意义互动的机会。学生们认为，那些不让学生接触复杂患者学习机会的带教老师，以及运转不良的医疗体系，是他们成长的关键限制因素。学习者强调了带教老师在他们学习经历中的重要作用，这限制了他们进行尝试并从有效失败中学习的能力，但他们认为，通过有指导的支架式教学和监督，这方面的教学和学习可以得到有意义的加强。
接触复杂患者并与他们互动提供了关键的学习机会，可能使学生能够探索并更好地培养应对复杂性的技能。通过适当的支架式教学，学生能够在临床学习环境中接受复杂性，这可能使他们有能力照顾复杂患者。
