A capability approach analysis of student perspectives of a medical consultation quality-improvement process

Abstract

Background. Research shows that person-centredness declines during medical education. This study examines the underlying assumptions and effects of clinical associate training interventions on person-centred practice.

Objectives. To understand student experiences of a medical consultation quality-improvement (QI) process in terms of a capability approach to learning and the effects of this process on their person-centredness.

Methods. In a randomised controlled trial students from 8 clinical learning centres (CLCs) participated in a qualitative, medical consultation QI process. Qualitative data (focus group discussions and reflective reports) were analysed using a capability approach to the learning framework.

Results. Learning was triggered by disruptions to students’ abilities, knowledge, identity and relationships. Through facilitated review-read-reflect-re/action scaffolded by feedback and practical assessment tools they learnt new person-centred consultation skills. The QI process functioned as a learning cycle in which students reviewed disruptions, identified areas for improvement and developed improvement plans. Through it, awareness of themselves developed more deeply, their relationships with peers and patients grew and they improved their knowledge and consultation skills.

Conclusions. Students demonstrated learning through their understanding of the skills and competencies required for person-centred practice. The study found students to be at different points along the directed/self-directed learning continuum, with most of them developing abilities to learn independently, work in groups, give and receive feedback and apply learning across different contexts. Facilitation is particularly important, given the uneven development of the ‘dimensions of a person’ at an individual level. Lastly, the capability approach is useful as an analytical framework and as a way of ‘doing learning’.