Developing a standardised patient programme in a primary healthcare curriculum: A needs analysis

Abstract

Background and objectives. The use of standardised patients (SPs) in medical education is well documented, mostly in developed settings. The aim of this study was to conduct a needs analysis for the development of a patient-centred SP programme within a primary healthcare (PHC)-led curriculum at the University of Cape Town (UCT) in South Africa, and to make recommendations for its development.

Methods. A mixed methods study was conducted which included focus groups with fourth-year medical students (n=17), a questionnaire for third-year medical students (n=181), a questionnaire for patients who were examined by students (n=28), and quantitative tracking of patient-student encounters.

Results. While students experienced significant challenges in sourcing suitable patients for interviewing and examination, the majority placed such value on the interaction with real patients that benefits outweighed the challenges. For students, challenges included seeing patients who had minor or no clinical signs in order to complete their portfolio tasks. For patients (especially those with clinical signs) it included being examined multiple times by students. Despite this, most patients expressed a desire to play a role in students’ education. The study revealed areas of tension and inconsistency with the philosophies of a PHC curriculum, specifically in the areas of patients’ rights and the role of patients as ‘active teachers’.

Conclusions. An SP programme at UCT could help with the skills development in second year. However, this role should include exploring the doctor-patient-student power relations with students, with a view to encouraging a more patient-centred professional identity for students.