`No trace anywhere of life, you say... imagination not dead yet, yes, dead, good, imagination dead imagine dead imagine.' Samual Beckett, Imagination Dead Imagine.
Abstract
Medical students must be prepared for working in inter-professional and multi-disciplinary clinical teams centred on a patient’s care pathway. While there has been a good deal of rhetoric surrounding patient-centred medical education, there has been little attempt to conceptualise such a practice beyond the level of describing education of communication skills and empathy within a broad ‚professionalism’ framework. Paradoxically, while aiming to strengthen patient–student interactions, this approach tends to refocus on the role modelling of the physician, and opportunities for potentially deep collaborative working relationships between students and patients are missed. A radical overhaul of conventional doctor-led medical education may be necessary, that also challenges the orthodoxies of individualistic student-centred approaches, leading to an authentic patient-centred model that shifts the locus of learning from the relationship between doctor as educator and student to the relationship between patient and student, with expert doctor as resource. Drawing on contemporary poststructuralist theory of text and identity construction, and on innovative models of work-based learning, the potential quality of relationship between student and patient is articulated in terms of collaborative knowledge production, involving close reading with the patient as text, through dialogue. Here, a medical ‚education’ displaces traditional forms of medical ‚training’ that typically involve individual information reproduction. Students may, paradoxically, improve clinical acumen through consideration of silences, gaps, and contradictions in patients as texts, rather than treating communication as transparent. Such paradoxical effects have been systematically occluded or denied in traditional medical education.
Similar content being viewed by others
References
Baron R. (1990). Medical Hermeneutics: Where is the ‘Text’ We Are Interpreting? Theoretical Medicine 11: 25–28
Bleakley A. (2002). Pre-registration house officers and ward-based learning: a ‘new apprenticeship’ model. Medical Education 36: 9–15
Bleakley A. (2006). Broadening conceptions of learning in medical education: the message from teamworking. Medical Education 40: 150–157
Bleakley A., Farrow R., Gould D., Marshall R. (2003). Making sense of clinical reasoning: judgement and the evidence of the senses. Medical Education 37: 544–552
Bleakley A., Boyden J., Hobbs A., Walsh L. (2004). Safety in operating theatres: Improving teamwork through team resource management. Journal of Workplace Learning 16: 83–91
Branch W.T. (2006). Teaching respect for patients. Academic Medicine 81: 463–467
Daniel S. (1986). The patient as text: a model of clinical hermeneutics. Theoretical Medicine 7: 195–210
De Certeau M. (1984). The Practice of Everyday Life. Berkeley: University of California Press
De Valck C., Bensing J., Bruynooghe R., Batenburg V. (2001). Cure-oriented versus care-oriented attitudes in medicine. Patient Education and Counselling 45(2): 119–121
Dogra N., Karnik N. (2003). First-year medical students’ attitudes toward diversity and its teaching: an investigation at one U.S. Medical School. Academic Medicine 78: 1191–1200
Engestrom Y. (2004). New forms of learning in co-configuration work. Journal of Workplace Learning 16: 11–21
Engestrom, Y. (2006). Collaborative intentionality capital: object-oriented interagency in multiorganizational fields. <http://www.edu.helsinki.fi/activity/people/engestro/>
Foucault M. (1972). The Archaeology of Knowledge. London: Tavistock Publications
Fulford K.W.M., Ersser S., Hope T. (1995). Essential Practice in Patient-centred Care. Oxford: Blackwell Science
Haidet P., Dains J.E., Paterniti D.A., Hechtel L., Chang T., Tseng E., Rogers J.C. (2002). Medical student attitudes toward the doctor-patient relationship. Medical Education 36: 568–574
Haidet P., Kelly P.A., Chou C.: Communication, Curriculum, Culture Study Group. (2005). Characterizing the patient-centeredness of hidden curricula in medical schools: development and validation of a new measure. Academic Medicine 80: 44–50
Hopkins P. (Eds) (1972). Patient Centred Medicine. London: Regional Doctor Publications
Howe A. (2001). Patient-centred medicine through student-centred teaching: a student perspective on the key impacts of community- based learning in undergraduate medical education. Medical Education 35: 666–672
Hunter K-M. (1993). Doctors’ Stories: The Narrative Structure of Medical Knowledge. Princeton, NJ: Princeton University Press
Inui T.S., Frankel R.M. (2006). Hello, Stranger: building a healing narrative that includes everyone. Academic Medicine 81: 415–418
Klitzman R. (2006). Improving education on doctor-patient relationships and communication: lessons from doctors who become patients. Academic Medicine 81: 447–453
Krupat E., Hiam C.M., Fleming M.Z., Freeman P. (1999). Patient-centeredness and its correlates among first year medical students. International Journal of Psychiatry in Medicine 29: 347–356
Lawton G. (2006). The incredibles. New Scientist 190(2551): 32–8
Leder D. (1990). Clinical interpretation: the hermeneutics of medicine. Theoretical Medicine. 11: 9–24
Macherey P. (2006). A Theory of Literary Production. London: Routledge
Masson N., Lester H. (2003). The attitudes of medical students towards homeless people: does medical school make a difference? Medical Education 37: 869–872
Miettola J., Mantyselka P., Vaskilampi T. (2005). Doctor-patient interaction in Finnish primary health care as perceived by first year medical students. BMC Medical Education 5: 34
Miller H. (1967). In sickness and in health. Encounter XXVIII(4): 10–21
Miller G.E. (1999). Adventure in pedagogy. Education for Health 12: 339–46
Mukohara K., Ban N., Sobue G., Shimada Y., Otani T., Yamada S. (2006). Follow the patient: process and outcome evaluation of medical students’ educational experiences accompanying outpatients. Medical Education 40: 158–165
Orr M. (2003). Intertextuality: Debates and Contexts. Cambridge: Polity Press
Pauli H.G., White K.L., McWhinney I.R. (2000). Medical Education, Research, and Scientific Thinking in the 21st Century. Education for Health. 13: 165–186
Phillips S.P., Ferguson K.E. (1999). Do students’ attitudes toward women change during medical school? Canadian Medical Association Journal 161: 127–128
Pinar W., Reynolds W.M., Slattery P., Taubman P.M. (1995). Understanding Curriculum. New York: Peter Lang
Ryder N., Ivens D., Sabin C. (2005). The attitude of patients towards medical students in a sexual health clinic. Sexually Transmitted Infections 81: 437–439
Silver-Isenstadt A., Ubel P.A. (1999). Erosion in medical students’ attitudes about telling patients they are students. Journal of General Internal Medicine 14: 481–487
Tervo R.C., Azuma S., Palmer G., Redinius P. (2002). Medical students’ attitudes toward persons with disability: a comparative study. Archives of Physical Medicine and Rehabilitation 83: 1537–1542
Thistlethwaite J.E., Jordan J.J. (1999). Patient-centred consultations: a comparison of student experience and understanding in two clinical environments. Medical Education 33: 678–685
Wahlstrom O., Sanden I., Hammar M. (1997). Multiprofessional education in the medical curriculum. Medical Education 31: 425–429
Walling A., Montello M., Moser S.E., Menikoff J.A., Brink M. (2004). Which patients are most challenging for second-year medical students? Family Medicine 36: 710–714
Woloschuk W., Harasym P.H., Temple W. (2004). Attitude change during medical school: a cohort study. Medical Education 38: 522–534
Virno P. (2004). A Grammar of the Multitude. Los Angeles, CA: Semiotext(e)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bleakley, A., Bligh, J. Students Learning from Patients: Let’s Get Real in Medical Education. Adv in Health Sci Educ 13, 89–107 (2008). https://doi.org/10.1007/s10459-006-9028-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-006-9028-0