Unravelling the learning of patient-centeredness: an Understanding of Learning Patient-Centeredness in Medical Education

The importance of patient-centered care is recognized in contemporary medicine, but implementing it in everyday health care and teaching patient-centeredness in medical studies remains challenging. In this thesis, we aim unravel how students learn patient-centeredness. We looked for the mechanisms that lead to the learning of patient-centeredness. To do so, we used several research methods. First, we describe two realist reviews, which analyzed educational interventions aimed at learning patient-centeredness through interaction with real patients and simulation/standardized patients, respectively. In subsequent chapters, we analyze a longitudinal educational intervention, in which students follow patients, to foster patient-centeredness. Our focus were the learning mechanisms involved in learning patient-centeredness (realist evaluation), what themes around this concept can be identified in what students write down in diaries (thematic analysis), and how students conceptualize patient-centeredness (discourse analysis). We conclude that real patients, simulation/standardized patients and the students, each in a particular role, can change the learning context. As a result, different learning mechanisms can be evoked. The thematic analysis showed that students mainly think about the fundamentals of patient-centeredness, lacking a view of the full breadth of the concept. They talk about patient-centeredness in terms of dilemmas they encounter in their encounters and in the degree of importance they attach to patient-centered care. With these insights, trainers and educators can design context-specific interventions and make refinements to medical education programs to effectively foster patient-centeredness.