Patient-centred care: The patients' perspective ­ a mixed-methods pilot study

Background: Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching. Aim: We attempted to determine whether the Western constructs of empathy were relevant in our context and also establish whether there were any parts of the medical interview which participants felt were especially important to be communicated to in their home language. Setting: Two urban communities within the City of Cape Town, Western Cape Province, South Africa. Methods: This was a mixed-methods pilot study using an explanatory sequential design. Participants who would typically make use of public health care facilities and whose first language was Afrikaans or isiXhosa were conveniently sampled. A subgroup of participants was invited to take part in a follow-up focus group discussion to add clarity to the survey responses. Results and Conclusion: Western constructs for empathy appeared to be relevant within our multicultural context. Patients wanted to communicate with their doctors and understand the cause of their problems as well as the management plan. Finally, whilst the numbers in this pilot study were too small to be generalisable, it was evident that patient-centred care was not perceived to be implemented in some public healthcare facilities attended by the participants, which resulted in them feeling unseen and disrespected

Measuring empathy in a group of South African undergraduate medical students using the student version of the Jefferson Scale of Empathy

Background: Patient-centred care is a model of care that demands healthcare providers change their focus from the disease to the patient and his or her perceived physical and psycho-social needs. This model requires healthcare workers to listen actively and to have effective communication skills and well-developed levels of empathy. Aim: The aim of this study was to determine the suitability of the Jefferson Scale for Empathy (JSE-S) as a valid test for empathy in third-year medical students at a South African university and also to determine the baseline level of empathy in this same group of students. Setting: The study took place at a medical school in the Western Cape, South Africa. This medical degree (MB ChB) is a 6-year programme. Students are first exposed to patients within their second year of training, but it is during their third-year that they start their clinical rotations. We wanted to test whether our empathy training would give students the necessary skills and enable them to establish good empathic communication habits in order to prevent a fall in empathy during this vulnerable period. Methods: This article explores the suitability of the student version of the JSE-S as a valid test for empathy, within the South African medical school context. We briefly discuss the psychometrics and the scores against what is already known in countries like ours, specifically, developing nations where cultural and language differences exist in the student populations. Furthermore, we explore whether the JSE-S is a valid scale for pre- and post-intervention measurement of medical student empathy within our context and discuss the limitations of self-assessment. We also report on baseline levels of empathy in third-year medical students. Results: Two hundred and six third-year medical students (69% females) completed the JSE-S prior to the intervention. Females and students aged 25 years and older had significantly higher scores than males and those 22 years old or less. The mean JSE was 109.98 (SD = 12.54), which is lower than most internationally reported scores. The Cronbach's alpha coefficient was 0.81, indicating scale reliability and consistency, but graded item response testing highlighted variance in three reverse-scored questions. Conclusion: The JSE-S is an appropriate and valid scale for measuring levels of empathy in undergraduate medical students in South Africa. However, language may need to be clarified in the negatively phrased items

In search of an effective teaching approach for skill acquisition and retention: teaching manual defibrillation to junior medical students

Introduction: Although overloaded curricula; the increasing student to educator ratio; limited resources; insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency; the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods : A randomised controlled trial design was used to compare the efficacy of the traditional; Peyton's four-stage; and a modified five-step method. Regarding the latter; George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught 'manual defibrillation'. Subsequent to the teaching session as well as at two months later; students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results: None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion: Considering that the three instructional approaches were similar in terms of skill acquisition and retention; incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment

Fresh simulation options in critical care nursing education

Context and setting The Critical Care (General) Nursing Programme in the Faculty of Health Sciences; Stellenbosch University; South Africa is a one-year post graduate programme. The practical component of the course consists of a number of individual practical procedures e.g. suctioning of the intubated patient as well as several case presentations. In order for students to be able to do a case presentation they need to understand and integrate the critically sick patient's disease process as well as the medical and nursing management. In order for the students to pass the case presentations satisfactory is often a challenge as a much higher cognitive level is expected than when performing the individual practical procedures. Why the idea was necessary During the course of the programme weekly individual clinical guidance is provided to the students at the bedside in the critical care units. The purpose of these bedside sessions is for the students to discuss the critically sick patients with a critical care nurse educator in order to develop their integration; reasoning and case presentation skills. Students however tend to use these teaching opportunities only to practice and to be assessed on the individual practical procedures. Therefore graduates often possess of the skills to do the individual practical procedures; but because they find it difficult to integrate and understand the patient's disease process they lack insight in the holistic picture of the patient. What was done A case study design was used for this study. The practical procedures identified as suitable for simulation were demonstrated; practiced and assessed in simulation in the Clinical Skills Centre (CSC). The study focused on describing how the tutors and students involved experienced the use of simulation as well as how the use of the CSC for reaching competency in some of the practical procedures impacted on the available teaching time in the clinical settings. Evaluation of results and impact The result of completing the majority of the practical procedures in simulation was that more time was available for the students to practice doing case presentations with the critical care nurse educators during their clinical teaching sessions. students and tutors valued the use of simulation and enjoyed the sessions in the CSC. The issue of how successful the transfer of learning from the CSC to the clinical areas takes place poses very valid questions when it comes to simulation. It is vital that students should be able to transfer the learning that has occurred in the simulated setting to the clinical context. Further research on this subject could serve to establish whether students can apply the procedures they have been assessed on in the CSC equally well on real patients; or; if not; what measures can be implemented to facilitate this process