Patient-centred consultations: a comparison of student experience and understanding in two clinical environments

Objectives To explore students' perspectives on doctor-patient communicatio n. Design We interviewed students in focus groups before and after their place ments. In semistructured interviews they were asked about their experiences of learning through clinical contact, with particular emphasis on patient- centred consultations, on the wards and during their community attachment. Students whose clinical skills training remained hospital-based were also i nterviewed to compare the range of experiences. Setting Leeds University. Subjects Third-year medical students. Results During hospital training students are rarely introduced, either thr ough teaching or observation, to the idea of patient-centred consultations. In contrast both the principles underpinning and/or the practice of such c onsultations were routinely encountered during the general practice placeme nt. Students considered the community attachment to have helped them apprec iate the value of exploring patients' concerns both in terms of enhancing t he patients' overall healthcare experience and promoting effective clinical management. While they considered the nature and purpose of hospital care to be qualitatively different from that conducted in the community, the rel evance of adopting a patient-centred approach on the wards was confirmed. Conclusions Recommendations for clinical training are made. The relevance a nd best use of community and hospital-based attachments need to be evaluate d further.