Does history-taking affect learning of attitudes?

How can medical students adopt a patient-oriented approach?

During the past 7 years approximately 60 preclinical and clinical students joined dynamically oriented group sessions on medical history-taking. An open-ended question technique was used.

The student's expectations of the patient were monitored by the repertory grid technique using a self-developed dyad grid form which allowed the estimation of reciprocal expectations as seen by the student. A main component analysis of the ratings obtained was performed.

The development in one group was taken as representative of the general development in the different groups. Two main components (MC I, II) were found to account for approximately 40 and 25% of the total variance (distance/empathy and dominance/dependence). The student's main concern is centered on the problem of dependence, MC II. He expects the patient to cling to him. Similarly he feels dependent on the psychosomatic lecturer. He feels as though he is the lecturer's patient. During group work the patient is seen to be less clinging. The student learns that he is not his lecturer's patient but his junior partner. He changes his professional ego-ideal as a future doctor. This is modelled according to his own relationship with the lecturer. It is not modelled according to the usual doctor-patient relationship as perceived by the student. The main characteristic of the change is a lessening of dependency needs as felt in the relationship to the patient.

The findings are interpreted as an attitudinal change in favour of a more patient-oriented attitude. The change was affected through confrontation with the patient's needs. Conclusions were drawn: The student has to be trained how to cope with dependency needs. Special learning settings have to be provided which are staffed with patient-oriented physicians.