Yaw-Wen Chang¹
Kwan Yeh², Chih-Chia Wang¹, Fang-Yih Liaw_¹ and Chin-Sheng Lin¹
1 Tri-Service General Hospital, National Defense Medical Center
2 Graduate Institute of Life Sciences, National Defense Medical Center

The Patient-Physician Alliance for Learning (Patient-PAL) program for penultimate year (5th year) medical students focuses on the continuity of patient care. A medical student has to follow up with four to six patients for about three to six months. In this study, we aimed to explore what and how medical students learned beyond medical knowledge. 

This was a mixed-methods study. We used a questionnaire and in-depth interviews to explore Patient-PAL students’ self-evaluations and learning processes. Twelve students participated in this program in 2021. We invited these students to complete the questionnaire and the interviews after finishing the Patient-PAL program in 2022. We used the social constructivist approach to collect and analyze data. 

In quantitative results, we found that the Patient-PAL students had higher self-rated scores on empathy and effective communication. In qualitative analysis, we found three major elements in this program: the student-patient relationship, patient-centered care, and a supportive learning environment. The longitudinal patient follow-up facilitated the development of the student-patient relationship. The students felt trusted by patients and connected with the patient, like a friend of theirs. The students learned empathy and the social determinants of health in this context. The students could provide patient-centered care. In addition to the instructions of preceptors, the students learned to establish effective communication by observing the preceptor’s behaviors or from experiences shared by peers. 

This study found that the student(doctor)-patient relationship is the core element. Continuity of care, the principle of the Patient-PAL program, encourages medical students to develop meaningful relationships with patients and their families. Based on this relationship, the students could have more effective communication and connection and earn patients’ trust, reinforcing their behaviors of demonstrating empathy, knowing patients’ socioeconomic backgrounds, and applying patient-centered care. The continuity with preceptors and peers also provided a supportive learning environment. 

References (maximum three) 

Bowen, J. L., Ilgen, J. S., Irby, D. M., Ten Cate, O., & O’Brien, B. C.(2017). “You have to know the end of the story”: Motivations to follow up after transitions of clinical responsibility. Academic Medicine, 92(11S), S48-S54. 

Chang, Y. W., Hirsh, D. A., Fang, W. H., Li, H., Tzeng, W. C., & Kao, S.(2021). Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study. BMC Medical Education, 21(1), 1-9. 

Grau Canét-Wittkampf, C., Eijkelboom, C., Mol, S., Zwart, D., Hendriks, I., & de Groot, E.(2020). Fostering patient-centrednessby following patients outside the clinical setting: an interview study. BMC Medical Education, 20, 1-8.