Interrogating patient-centredness in undergraduate medical education using an integrated behaviour model

Background: Patient-centredness, an approach that puts the patient at the centre of the consultation, thus focusing on patients instead of on his/her diseases, has been identified by most medical schools as a desired core competence of their graduates. Despite some curriculum initiatives, medical students often display a lack of patient-centredness upon graduation. This bears reason for concern and it was thus deemed important to explore possible factors that influence the teaching and learning of patient-centredness in an undergraduate medical curriculum. The article suggests a framework that can assist programme developers to conceptualise the teaching and learning of patient-centredness across an undergraduate curriculum. Methods: A qualitative exploratory case study design was used for the study with final-year medical students. Themes of meaning were deduced from the data by employing components of an Integrated Behavior Model (IBM) of Fishbein. Results: The findings of the study revealed that seven factors play a role: background characteristics of students, attitudinal factors, subjective norms (the hidden curriculum), student self-efficacy, acquired skills and knowledge, the environment or context within which patient-centredness is taught and learnt, as well as assessment of learning. Conclusions: Patient-centredness is a complex construct and authors often write about only one of its components. This paper attempts to consider the total undergraduate medical curriculum students are exposed to when they learn about being patient-centred. The teaching and learning of such a multidimensional construct require a comprehensive approach in order to be effective and the IBM seems to be a useful and applicable theoretical model to apply.