Care-ing about patients: the construction, performance, and organization of communication and care in medical education

2010 Fall.Includes bibliographical references.In an era where health care is becoming increasingly expensive and reform is on the political agenda, it is important to understand what specifically can be reformed or altered to change the way health care is both understood and administered. To begin, what can be revealed through analyzing the way that health care providers themselves understand both care and communication? This master's thesis uses a dialogic approach to understand how both communication and care are taught and understood in medical education programs. Medical educators at five medical schools in the United States were interviewed regarding their role in teaching communication and clinical skills at their respective schools. Interview data was coded and categorized in effort to better understand how each school constructs and performs the concepts of communication and care. After uncovering how these ideas are understood, suggestions were put forth regarding how medical education curriculums might be changed in the future to better equip future doctors with the demands of delivering quality health care to a multitude of patients with varying desires, needs, and understanding of what it means to be "healthy". After analyzing interview data, this study reveals that the ways in which medical students understand communication and care have material implications for the ways they engage in clinical interactions. Therefore, altering the way these concepts are understood can potentially change the ways doctors interact with their patients. In a time when health care is changing drastically each year, these findings provide tools to make cost and time effective changes in medical education that create important changes for future of medicine. The specific changes offered by this study provide a framework for future curriculums to follow to ensure that programs meet accreditation standards, while also providing the most innovative and advanced teaching and learning methods to educate future doctors. While the sample used for this study is small, its findings still illustrate how medical education might change to better educate students. Further, the study illustrates a need for change and suggests how the methods used here might be combined with others to reveal further areas of focus for curriculum reform. The conclusions of this study reveal that health care reform can begin in the context of medical education and how reconceptualizing foundational ideas like communication and care can better equip medical students for their future clinical interactions