The Effect of a Structured, Home-based Interview With a Patient With a Chronic Illness on First-year Medical Students' Patient-centredness: a Randomised Controlled Trial.

Background Doctors are regarded as "professionals" both by the public and by their peers [Medical Protection Society, 2017]. They are the most trusted profession among the public, and this has been the case for many years. Medical professionalism is not a new concept and has been present in the history of medicine in the form of a Hippocratic Oath taken by physicians [Seif-Farshad M, Bazmi S, Amiri F, et al, 2016]. However, medical professionalism is difficult to define and remains poorly understood [Riley S, Kumar N, 2012]. While professionalism has become a widely emphasised subject in medical education and medical practice, there is still a lack of common understanding about the meaning of the concept. Discussions on the subject have thus been unsystematic, as the word "professionalism" has multiple meanings, complexities, and subtle differences [Seif-Farshad M, Bazmi S, Amiri F, et al, 2016].

Professional healthcare groups have their own set of norms (codes) which guide members of that profession in terms of how they should behave professionally. [Monrouxe V, Rees C, 2017] These are designed and implemented by the profession's regulatory body, so differ according to different healthcare professions and countries. Over one hundred different dimensions of professionalism have been identified. Swick [2000] proposes that medical professionalism consists of specific behaviours (Table 1).

Concerns about professionalism in medicine have made the explicit teaching and learning of ethics, professionalism and personal development necessary. The General Medical Council in the UK, and other professional bodies in both Europe and the Americas, have emphasised the need to enhance the teaching and learning of professionalism in medical schools, particularly the development of good attitudes, appropriate and competent skills, and the inculcation of a value system that reflects the principles of professionalism in medicine [Sivalingam, 2004].

A study investigating tutors' and students' perspectives of the delivery of professionalism in the early years of Glasgow's learner-centred, problem-based learning (PBL) medical curriculum found that [Goldie J, Dowie A, Cotton P, et al, 2007]: early patient contact experiences were found to be particularly important, and that learning activities promoting critical reflection were most effective. However, a systematic review found no unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum [Birden H, Glass N, Wilson I, et al 2013]. There is no consensus about how best to teach professionalism [Stockley AJ, Forbes K, 2014], and few studies have explored the effectiveness of different teaching and learning methods for professionalism [4].

Research on students' understandings of professionalism identified 19 dimensions [Monrouxe V, Rees C, 2017]. Of these, patient-centredness was the second most discussed dimension (after 'professionalism as rules'). Students' ideas of patient-centred professionalism came from a variety of sources: formal lectures on ethics, informal learning through role models, and from formal assessments. In the patient-centred clinical method, both the physician's and the patient's agendas are addressed by the physician and any conflict between them dealt with by negotiation [Levenstein JH, McCracken EC, McWhinney IR, et al, 1986]. This means that the physician aims to gain an understanding of the patient as well as the disease, and it is in contrast to the disease-centred method in which only the doctor's agenda is addressed. Summarising patient-centeredness elegantly, McWhinney describes the patient-centred approach as one where the "physician tries to enter the patient's world, to see the illness through the patient's eyes" [McWhinney 1989]. Evidence suggests that patient-centred care is associated with a number of favourable biomedical, psychological and social outcomes [Bauman AE, Fardy HJ, Harris PG, 2003], and it has been recognised as an important aspect of quality in health care [Institute of Medicine Committee on Quality of Health Care, 2001].