Managing the complexity of doing it all: an exploratory study on students’ experiences when trained stepwise in conducting consultations
Open accessAbstract
BACKGROUND: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. METHODS: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. RESULTS: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. CONCLUSION: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Simulation in medical education allows students to repeat a given scenario as many times as needed, make mistakes, learn from errors, ponder, receive proper feedback, trace a learning curve, and improve clinical skills without compromising patients' safety, as well as reduce stress from direct interaction with real patients.
“Simulation emerges as a new medical educational strategy allowing students to repeat a given scenario as many times as needed, make mistakes, learn from errors, ponder, receive proper feedback, trace a learning curve, and finally, improve the clinical skills required in clinical practice without compromising patients’ safety, as well as to reduce the stress produced by direct interaction with real”
From The virtual patient as a learning tool: a mixed quantitative qualitative study (2018) · cites this paper as [10]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Situated Learning: Legitimate Peripheral Participation.
Bloch, M. E. F., Lave, J., & Wenger, É. (1994) · Man · doi:10.2307/2804509 · Cited by 39,323 · see citing works
Lave, J., & Wenger, E. (1991) · Cambridge University Press eBooks · doi:10.1017/cbo9780511815355 · Cited by 33,219 · see citing works
Design Experiments in Educational Research
Cobb, P., Confrey, J., diSessa, A., Lehrer, R., & Schauble, L. (2003) · Educational Researcher · doi:10.3102/0013189x032001009 · Cited by 3,548 · see citing works
Design-based research and technology-enhanced learning environments
Wang, F., & Hannafin, M. J. (2005) · Educational Technology Research and Development · doi:10.1007/bf02504682 · Cited by 2,241 · see citing works
Consequences of individual feedback on behavior in organizations.
Ilgen, D. R., Fisher, C. D., & Taylor, M. S. (1979) · Journal of Applied Psychology · doi:10.1037/0021-9010.64.4.349 · Cited by 1,822 · see citing works
Cognitive load theory in health professional education: design principles and strategies
Van Merriënboer, J. J. G., & Sweller, J. (2010) · Medical Education · doi:10.1111/j.1365-2923.2009.03498.x · Cited by 1,511 · cited 7× · see citing works
“Van Merriënboer & Sweller developed specific instructional design guidelines to manage complex learning tasks [12].”
BackgroundInfluentialThe Doctor, His Patient, and the Illness
BALINT, M. (1957) · Postgraduate Medical Journal · doi:10.1136/pgmj.33.382.417-a · Cited by 1,270 · see citing works
Design Research: What We Learn When We Engage in Design
Edelson, D. C. (2002) · Journal of the Learning Sciences · doi:10.1207/s15327809jls1101_4 · Cited by 981 · see citing works
Harlem, O. K. (1972) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.1972.tb02548.x · Cited by 898 · see citing works
THE DOCTOR, HIS PATIENT, AND THE ILLNESS
Bálint, M. (1955) · The Lancet · doi:10.1016/s0140-6736(55)91061-8 · Cited by 799 · see citing works
The Consultation: An Approach to Learning and Teaching.
(1984) · Annals of Internal Medicine · doi:10.7326/0003-4819-101-4-577_2 · Cited by 582 · see citing works
Marrying Content and Process in Clinical Method Teaching
Kurtz, S. M., Silverman, J., BENSON, J. A., & Draper, J. (2003) · Academic Medicine · doi:10.1097/00001888-200308000-00011 · Cited by 572 · see citing works
Educating Physicians: A Call for Reform of Medical School and Residency
Shulman, L. S., Cooke, M., OʼBrien, B. C., & Irby, D. M. (2010) · Medical Entomology and Zoology · Cited by 512 · see citing works
The Carnegie Foundation for the Advancement of Teaching
Harper, F. V. (1909) · Science · doi:10.1126/science.29.740.378 · Cited by 439 · see citing works
Opportunity or threat: the ambiguity of the consequences of transitions in medical education
Teunissen, P. W., & Westerman, M. (2011) · Medical Education · doi:10.1111/j.1365-2923.2010.03755.x · Cited by 342 · see citing works
Students' opinions about their preparation for clinical practice
Prince, K. J. A. H., Boshuizen, H. P. A., Van Der Vleuten, C. P. M., & Scherpbier, A. J. J. A. (2005) · Medical Education · doi:10.1111/j.1365-2929.2005.02207.x · Cited by 301 · see citing works
Patient‐oriented learning: a review of the role of the patient in the education of medical students
Spencer, J., Blackmore, D. E., Heard, S., McCrorie, P., McHaffie, D., Scherpbier, A. J. J. A., Gupta, T. S., Singh, K., & Southgate, L. J. (2000) · Medical Education · doi:10.1046/j.1365-2923.2000.00779.x · Cited by 294 · see citing works
The consultation: an approach to learning and teaching
Wilson, P. H. (1985) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.1985.tb120003.x · Cited by 225 · see citing works
Helping students learn to think like experts when solving clinical problems
Mandin, H., Jones, A., Woloschuk, W., & Harasym, P. H. (1997) · Academic Medicine · doi:10.1097/00001888-199703000-00009 · Cited by 209 · see citing works
Bokken, L., Rethans, J., van Heurn, L., Duvivier, R. J., Scherpbier, A. J. J. A., & van der Vleuten, C. P. M. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181a814a3 · Cited by 180 · see citing works
Bokken, L., Rethans, J.-J., Scherpbier, A. J. J. A., & van der Vleuten, C. P. M. (2008) · Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e318182fc56 · Cited by 174 · see citing works
Clarifying students’ feedback‐seeking behaviour in clinical clerkships
Bok, H. G. J., Teunissen, P. W., Spruijt, A., Fokkema, J. P. I., van Beukelen, P., Jaarsma, D. A. D. C., & van der Vleuten, C. P. M. (2013) · Medical Education · doi:10.1111/medu.12054 · Cited by 155 · see citing works
Teaching and assessing communication skills in Maastricht: the first twenty years
van Dalen, J., Bartholomeus, P., Kerkhofs, E., Lulofs, R., van Thiel, J., Rethans, J., Scherpbier, A. J. J. A., & van der Vleuten, C. P. M. (2001) · Medical Teacher · doi:10.1080/01421590120042991 · Cited by 123 · see citing works
Bokken, L., Rethans, J.-J., Jöbsis, Q., Duvivier, R., Scherpbier, A., & van der Vleuten, C. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181c48130 · Cited by 102 · see citing works
Patient-centredness from education to practice: The ‘lived’ impact of communication skills training
Bombeke, K., Symons, L., Vermeire, E., Debaene, L., Schol, S., Winter, B. Y. D., & Royen, P. V. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.670320 · Cited by 77 · see citing works
van Weel-Baumgarten, E. M., Bolhuis, S. M., Rosenbaum, M., & Silverman, J. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2012.12.004 · Cited by 63 · see citing works
The curriculum of communication skills teaching at Maastricht Medical School
van Dalen, J., Zuidweg, J., & COLLET, J.-F. (1989) · Medical Education · doi:10.1111/j.1365-2923.1989.tb00812.x · Cited by 63 · see citing works
Verdonk, P., Räntzsch, V., de Vries, R., & Houkes, I. (2014) · BMC Medical Education · doi:10.1186/1472-6920-14-96 · Cited by 57 · see citing works
van Hell, E. A., Kuks, J. B. M., Raat, A. N. J., et al. (2008) · Medical Teacher · doi:10.1080/01421590802144294 · Cited by 43 · see citing works
Sutter, C., & Reid, T. (2012) · Journal of Palliative Medicine · doi:10.1089/jpm.2012.0019 · Cited by 29 · see citing works
Widyandana, D., Majoor, G. D., & Scherpbier, A. J. J. A. (2010) · Education for Health · doi:10.4103/1357-6283.101478 · Cited by 16 · see citing works
Menahem, S. (1987) · Journal of the Royal Society of Medicine · doi:10.1177/014107688708000304 · Cited by 12 · see citing works
Veening, E. P., Gans, R. O. B., & Kuks, J. B. M. (2009) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-7995-8 · Cited by 7 · see citing works
Through the eyes of a medical student
Jacobson, D. (2013) · Perspectives on Medical Education · doi:10.1007/s40037-013-0082-z · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6920/14/206/prepub
Cited by
Sorted by citations
The virtual patient as a learning tool: a mixed quantitative qualitative study
Isaza-Restrepo, A., Gómez, M. T., Cifuentes, G., & Argüello, A. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1395-8 · Cited by 129 · see citing works
- Authors
- Aper, L., Reniers, J., Derese, A., & Veldhuijzen, W.
- Affiliations
- Ghent University (BE)
- Maastricht University (NL)
- Corresponding author
- Aper, Leen
- Venue
- BMC Medical Education
- Published
- 2014-09-26
- Volume
- 14
- Issue
- 1
- Pages
- 206-206
- ISSN
- 1472-6920 (ISSN-L)
- PMC
- PMC4181426
- OpenAlex
- W2034202173
- Cited by
- 13
- References
- 35
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 1
- FWCI
- 1.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medical Education (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Keywords
- consultation skills, medical students, curriculum integration, stepwise teaching, clinical reasoning, clinical communication, supervisor feedback, student anxiety, standardized patients, pre-clerkship education, transmission of medical knowledge
- MeSH terms
- Attitude of Health Personnel, Clinical Clerkship, Clinical Competence, Communication, Curriculum, Humans, Mentors, Netherlands, Problem Solving, Referral and Consultation, Students, Medical, Patient Simulation, Focus Groups
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
