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Students who underwent educational intervention were more likely to contextualize care
Schwartz A. JAMA. 2010;304:1191-1197.
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Results from a quasi-randomized controlled trial showed that medical students are more likely to tailor care to individual patients after undergoing a course on identifying individual patient circumstances.
Sixty-five fourth-year students at the University of Illinois College of Medicine in Chicago volunteered to undergo four weekly, case-based, 1-hour sessions to learn how to contextualize patient care using six concepts:
- The four components of clinical expertise — clinical state, research evidence, patient context and patient preferences.
- The role of patient context in clinical expertise.
- Domains of patient context — cognitive abilities, emotional state, cultural and spiritual beliefs, access to care, social support, caretaker responsibilities, attitudes to illness, relationship with clinicians and economic situation.
- Contextual red flags.
- Contextual assumptions — assumptions about a patient’s context that may be correct or incorrect.
- Errors in management caused by not taking into account patient context.
Another 59 students served as a control group and did not undergo the intervention.
Students with training in contextualization probed for these issues significantly more than the control group (mean 90% vs. mean 62%, respectively). Students in both groups probed for biomedical red flags in 77% of patient encounters, but the intervention group probed for contextual red flags in 86% of encounters compared with 61% for the control group (OR=3.75; 95% CI, 1.59-8.77).
Students in the intervention group were more likely than the control group to write an appropriate intervention plan, in 67% of encounters vs. 24%. Additionally, probing was associated with a higher likelihood that students would write an appropriate treatment plan. Students in the intervention group who investigated the contextual red flag wrote appropriate treatment plans 71% of the time compared with 57% of the time in the control group. Students wrote an appropriate plan only 4% of the time when the contextual red flag was not probed.
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