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Patients’ Perspectives on Physicians’ Roles: Implications for Curricular Reform

Boudreau, J Donald MD; Jagosh, Justin MA; Slee, Roger PhD; Macdonald, Mary-Ellen PhD; Steinert, Yvonne PhD

doi: 10.1097/ACM.0b013e31817eb4c0
Curriculum Development and Reform

Purpose: To elucidate the perspectives of patients on the conceptual framework for a new undergraduate medical curriculum organized around the healer and professional roles of the physician (their physicianship), and to illustrate how these perspectives can affect program development.

Method: In 2006, using an adapted interpretive description design and semistructured interviews, the authors collected data from a sample of 58 patients receiving care in a major academic medical center.

Results: Three findings were particularly salient. (1) The concepts of the physician as healer and professional, although central to the curriculum, did not resonate strongly with patients. The words professionalism and healer occasionally accrued negative connotations. There was little concordance between the lexicon patients use to describe ideal physician behaviors and a faculty-defined list of core physicianship attributes. (2) The listening skills of physicians were highly valued and seen as an “essentia” of ideal doctoring. (3) Being treated as a number by physicians represented a threat to patients’ personal identity.

Conclusions: This study found important differences between patients’ and physicians’ perspectives on key curricular concepts. Understanding these differences represents an important resource for program design and development. The findings also suggest avenues for future research on highly topical issues such as professionalism.

Dr. Boudreau is associate professor of medicine, director, Office of Curriculum Development, and core member, Centre for Medical Education, Faculty of Medicine, McGill University, Montréal, Canada.

Mr. Jagosh is a PhD candidate, Simon Fraser University, Vancouver. When this article was written, he was a research assistant, Faculty of Medicine, McGill University, Montréal, Canada.

Dr. Slee is research chair in inclusive education, Institute of Education, University of London, London, United Kingdom. When this article was written, he was dean, Faculty of Education, McGill University, Montréal, Canada.

Dr. Macdonald is assistant professor, School of Nursing and Department of Oncology, core member, Centre for Medical Education, and chair, McGill Qualitative Health Research Group, McGill University, Montréal, Canada.

Dr. Steinert is professor of family medicine, associate dean, Faculty Development, and director, Centre for Medical Education, McGill University, Montréal, Canada.

Correspondence should be addressed to Dr. Boudreau, Room 633, McIntyre Medical Sciences Building, McGill University, 3655 Promenade Sir William Osler, Montréal, QC, H3G 1Y6; telephone: (514) 398-5613; fax: (514) 398-3595; e-mail: (donald.boudreau@mcgill.ca).

The authors are grateful to the patients who participated in the study and the physicians and nurses of the McGill University Health Centre who assisted in their recruitment. The authors also acknowledge their collaboration with Ingram & Company, New York, New York, who assisted the Office of Curriculum Development in designing a strategy for program evaluation. In particular, they acknowledge the contribution of Lois Ingram, who inspired this study and helped to define a recruitment matrix. Finally, the authors thank the Academic Medicine reviewers and editorial staff–the reviewers, for their extremely perceptive and helpful suggestions, and the staff for their exemplary professionalism and client-centeredness.

© 2008 Association of American Medical Colleges