Department of Medicine

Chair's Column: Person-Centred Care Education: Putting the perspectives and experiences of our patients and families first

May 8, 2019
Author: 
Drs. Ayelet Kuper, Lisa Richardson and Gillian Hawker

Person-Centred CareWhen we sit down with our patients, we know it’s important for us to see them for who they are as people. We know that each person has a unique story and lived experience that brought them into our care. We know that they are more than a combination of symptoms or co-morbidities, and more than a diagnostic problem to be solved. We know this, and therefore we know that it’s important that we care for our patients, and not just their diseases. That it’s important to acknowledge and understand the social determinants that contributed to their health. But, in the midst of busy service schedules, tests and diagnoses, it is possible to lose sight of the person for whom we are caring. 

The Department of Medicine’s number-one priority is to Ensure that the perspectives and experiences of our patients and their families drive our work. At the core of this priority is person-centred care (PCC), the practice of medicine that fully engages the patients - their preferences, experiences and needs – in all decision-making. To deliver PCC, one must recognize that each patient comes with a unique life story and social context. It is important therefore to attend to the care of the individual as well as the broader aspects of health care and society that contribute to that care, including issues of equity, diversity and inclusion.

Person-centred care isn’t a new concept, but it is a skill that needs to be fostered and deliberately taught. That’s why the Department of Medicine recently launched the Person-Centred Care Education initiative to formally integrate PCC into our teaching. This initiative aims to develop and deliver curriculum related to PCC for all department trainees. As we wrote for a post for the Faculty of Medicine, the PCC curriculum focuses on social science areas such as power, culture, equity, and reflexivity, as well as concepts like cultural safety, which are central to providing appropriate care for Indigenous and other patients from structurally marginalized groups.

Our PCC teaching is built upon three frameworks:

  1. The CanMEDS Knowledges Project: Understanding how to care for patients, and not just their diseases.
  2. Cultural Safety and the Care of Structurally Marginalized Groups: Understanding the structural barriers to optimal health faced by marginalized groups and physicians’ roles in advocating for change.
  3. Dialogic Teaching and Learning: Understanding that in order to provide compassionate, equitable, culturally safe care, trainees need to learn to reflect on their practice, to recognize and honour patients’ stories, and to engage in dialogue with their peers, patients, and teachers.

As we developed this new curriculum, we’ve worked with outstanding clinician-teachers and educators in Toronto to develop an approach to teaching PCC through dialogue, which encourages learners to ask questions they may not have previously considered. For example, educators asking open-ended questions is a form of dialogic teaching that can facilitate a better and more meaningful understanding of patient needs and experiences. This enables us to promote a keen awareness of the patient experience, an orientation to health equity and cultural safety, and an openness to the ideas and needs of diverse learners and patients — in the classroom and especially the clinic.

A group of U of T faculty members – Drs. Ayelet Kuper, Victoria Boyd, Paula Veinot, Tarek Abdelhalim, Mary Bell, Zac Feilchenfeld, Umberin Najeeb, Dominique Piquette, Shail Rawal, Rene Wong, Sarah Wright, Cynthia Whitehead, Arno Kumagai and Lisa Richardson – most of whom are from the Department of Medicine, will be publishing a paper in the Journal of Graduate Medical Education next month that describes their early experiences implementing a dialogical approach to person-centred care. The article includes many tips for effective dialogic teaching, such as purposefully creating a space for dialogue (which can make conversations more productive since rapport is built faster) and using open-ended questions. To be sent a copy of the journal article once it is published, please email Dr. Kuper at ayelet.kuper@utoronto.ca.

Another example of a person-centred approach to education is a strategy that Dr. Kuper uses to teach and talk about patient-centred care whenever she starts working with a new group of medical students and residents on the Internal Medicine wards. She wrote about it in a blog post for the AMS Phoenix Project, where she described the ‘trick’ she shares with her trainees for always making sure she’s caring for patients as though they are the most important, highest priority patients in the hospital:

“When I have trouble bringing my focus back to the patient […] I remind myself that that patient was once a baby that someone held as I have held my own babies. I remind myself that someone […] may still love them that much – and that even if they have nobody left in the world, I need to treat them as people still deserving of that sort of love.”

Although this approach can sometimes feel at odds with the medical culture in which many of us were trained, it’s just one way to remind us to bring the people who we are caring for to the forefront and engage in dialogue with our learners. We invite you to share your own ways of teaching person-centred care, or the strategies you use to keep yourself grounded and put the person first.

On May 15, Dr. Kuper will be presenting on Person-Centred Care Education at City-Wide Medical Grand Rounds. We invite you to join us for this talk. She’ll be discussing the links between traditional medical knowledge, current medical education, and the provision of compassionate, equitable medical care; highlighting concepts from the social sciences and humanities that underpin an understanding of person-centred care and introducing an approach to teaching for compassion and social justice.