What medical students and residents learned from reflection through patients' perspectives: a qualitative study.

Objectives:  The purposes of this study were to identify reflective processes from patients' points of view for difficult patient-doctor interactions and learn how the processes made medical students and residents aware of their own medical practice.  These processes were compared in two countries (US and Japan).

Methods:  The study was a descriptive qualitative study utilizing semi-structured interviews.  Participants were from US and Japan.  We analyzed the data using reflective thematic analysis of the implementation of reflections (from a patient's point of view) into medical clinical education and training from a constructivism paradigm.

Results:  We included twenty participants each from US and Japan by convenience sampling.  The participants were medical students during clinical clerkship and post graduate year-1, 2, and 3 medical residents.  Medical students and residents realized four cognitions (different expectations of patients and doctors, language communication barrier, time restriction and healthcare system challenges) from reflections from patients' perspectives.  Subsequently, medical students and residents identified three types of awareness (appropriate communication, empathy, and patient-doctor relationship of trust).  During these reflections from patients' perspectives, the medical students and residents had a willingness to change future behavior.

Conclusions:  This study revealed one aspect of medical students' and residents' cognitions and awareness of clinical experiences through reflection from patients' perspectives.  This cognitive process aligns the ideas of medical students and residents more closely with the patients' perceptions and influences their willingness to change their behavior. This process enables comprehensive realization in person-centered care.