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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
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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.

Posted on August 5, 2014
Conflict of Interest: None Declared
This comment is in response to the article “patient- and family-centered medical education: the next revolution in medical education” by Weinberger, Johnson, & Ness. I have been a registered nurse for four years, and I currently work for medical center of Lewisville as a rehabilitation nurse. I am a graduate student in the nursing administration program currently studying the nurse leadership. It was a delight to come across this article that addresses the importance and need to implement patient and family centered medical education because patient education is lacking in today’s health care. Patient and family are not given enough information on their diagnosis or treatment. An important requirement for patient centered care is effective communication between the patient and health professionals which is centered on patient's values, preferences, and needs (Weinberger, Johnson, & Ness, 2014). Almost all of the patients in the rehabilitation unit discharge home to the care of family, so it is important that the healthcare providers properly educate these patients and their caregivers.

I have worked with patients who do not know their medications or even the discharge instructions provided to them from the hospital. These patients complain that the healthcare providers only tell them they are discharged home, and hand over their discharge instructions with prescriptions. My current work place emphasizes the importance of patient and family education. The nurses educate the patients every shift, and each medication given must be thoroughly explained. The unit supervisors and managers perform daily rounds on each patient to ask if their medications and diagnosis have been explained. When we discharge a patient, three nurses must check off the discharge medications and instructions. According to Tamura-Lis (2013, p. 269), “individuals that experience health illiteracy receive less preventive care and have poor understanding of health problems and care, increase use of emergency and inpatient services and increase rates of re-hospitalization, decrease adherence to medication schedules, decrease participation in medical decision making, higher medical costs, and inefficient mix of health care service use”.

Patients and families should be included in the training environment not only as the recipients of care but also as teachers and, more routinely, as evaluators of the staffs ((Weinberger, et al., 2014). If patients are effectively educated, their quality of care and safety will be positively impacted, thus leading to improved patient satisfaction (Tamura-Lis, 2013). It is imperative that nursing leaders introduce and adopt a culture where the staffs properly educate patients and their family members on all medical aspect of their health, and the leaders should receive feedback from the patients. They should also include all patients and their family members in all aspect of their healthcare, and they should be provided with reading materials and tutorials to help with understanding of their care.


Ima Jackson, RN, BSN
Email: ima.jackson@mavs.uta.edu

Tamura-Lis W. Teach-Back for Quality Education and Patient Safety. Urologic Nursing [serial online]. November 2013;33(6):267-298. Available from: Academic Search Complete, Ipswich, MA. Accessed August 5, 2014.
Weinberger SE, Johnson BH, Ness DL. Patient- and Family-Centered Medical Education: The Next Revolution in Medical Education?. Annals of Internal Medicine. 2014;161:73-75. doi:10.7326/M13-2993
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