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Patient- and Family-Centered Medical Education: The Next Revolution in Medical Education?Patient- and Family-Centered Medical Education

Steven E. Weinberger, MD; Beverley H. Johnson, BSN; and Debra L. Ness, MS
[+] Article and Author Information

This article was published online first at www.annals.org on 22 April 2014.

From the American College of Physicians, Philadelphia, Pennsylvania; Institute for Patient- and Family-Centered Care, Bethesda, Maryland; and National Partnership for Women & Families, Washington, DC.

Acknowledgment: The authors thank Wendy Nickel for her critical review and input.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2993.

Requests for Single Reprints: Steven E. Weinberger, MD, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, sweinberger@acponline.org.

Current Author Addresses: Dr. Weinberger: Executive Vice President and Chief Executive Officer, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Ms. Johnson: President and Chief Executive Officer, Institute for Patient- and Family-Centered Care, 6917 Arlington Road, Suite 309, Bethesda, MD 20814.

Ms. Ness: President, National Partnership for Women & Families, 1875 Connecticut Avenue NW, Suite 650, Washington, DC 20009.

Ann Intern Med. 2014;161(1):73-75. doi:10.7326/M13-2993
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The importance of health care professionals partnering with patients and families has been recognized as an essential component of a high-quality, cost-efficient health care system. In this commentary, the authors propose changes in medical education and the training environment that have the potential to produce clinicians who are better able to address the needs of patients and their families.

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Posted on May 2, 2014
Kim Blake, MD, Sarah Manos, MD
IWK Health Center, Canada
Conflict of Interest: None Declared

I was very interested in the recent article titled Patient-and Family-Centered Medical Education: The Next Revolution in Medical Education? 1 As a pediatrician and educator I teach and practice patient centered medical education both on the ward and in the ambulatory clinics. At our institution we have taken this one step further and have involved the adolescent patients in a teaching role. We have accomplished this by producing the Structured Communication Adolescent Guide (SCAG) which is a validated tool that can be used with standardized patients (SP’s) 2 and real adolescent patients 3 to give feedback to trainees.

In a lecture theatre setting, the Med 1 students observe a doctor interviewing a mother and adolescent SP pair. Students and SP’s have a copy of the SCAG and they are asked to score the doctor who is doing the interview, and to offer feedback. In Med 2 the students go on to practice with a standardized patient at our learning resource centre. The students are expected to separate the SP parent from the adolescent, discuss confidentiality and risk taking issues. The students receive structured feedback from the SP pair using the SCAG.

In the pediatric clerkship, Med 3, students are required to interview at least two adolescent patients and ask for written feedback from the adolescents using the Structured Communication Adolescent Guide, which the students then pass in as part of their assessment. The comment section often contains useful feedback for the student e.g. “you forgot to ask if I am interested in boys or girls or both”.

Having a structured approach to a challenging area of clinical interviewing is vital. The adolescent years are a struggle for both trainees and doctors in practice. For internal medicine residents it is important to continue using a structured approach to their younger population, making sure there is dialogue on subjects such as alcohol, drugs, sex and depression.

Along similar lines as the SCAG, the Comprehensive Geriatric Assessment Guide (cGAG) 4 has been developed for the geriatric population. Both tools focus on patient feedback and have been adopted in a number of medical schools across Canada. Our adolescent and geriatric patients have been eager to fill out the formative feedback on the trainees and feel that their point of view is being considered and that they are helping to train the next generation of doctors.

The SCAG is available in in French, Spanish, German, Mandarin, Arabic and English 5.

1. Weinberger SE, Johnson BH, Ness DL. Patient and Family Centered Medical Education: The Next Revolution in Medical Education? Annals of Internal Medicine, April 2014.
2. Blake KD, Kutcher M, Wakefield S, Murphy J, Mann K. Structured Communication Adolescent Guide (SCAG): Assessment of Reliability and Validity to Residents and Physicians. Medical Education 2005; 39: 482–491
3. Kutcher M, Wakefield S, Mann K, MacCuspie J, Murphy J, Blake K. Rating a Physician by Adolescents Using the Structured Communication Adolescent Guide (SCAG). The Internet Journal of Medical Education. 2010, V 1 No 2
4. Diachun LL, Klages KB, Hansen KT, Blake K, and Gordon J. The Comprehensive Geriatric Assessment Guide: An Exploratory Analysis of a Medical Trainee Performance Evaluation Tool. Academic Medicine, Vol. 87, No. 12 / December 2012
5. Blake K, Allen L. Nelson Essentials of Pediatrics, Seventh Edition, Section 12 Adolescent Medicine page 234.

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