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Training interaction in primary care emergency teams: the role of the patient

Helen Brandstorp, Anna Luise Kirkengen, Peder A. Halvorsen, Birgitte Sterud, Bjorgun Haugland


Objective: “The needs of the patient” inform interactions in medical settings. Information regarding the role of the patient is, however, absent from emergency medicine guidelines and team training manuals. We sought to identify how we could introduce a greater focus on the needs of the patient in order to increase the person-centeredness of clinical services.

Method: During the course of one year (May 2010-11), we applied a framework of action research to an exploration of the simulated patient’s role and participation in the context of interaction training in primary care emergency teams in Alta, a rural municipality in the county of Finnmark, Norway. All of the 10 rounds of team trainings we employed included 2 simulated scenarios. Each was followed by a de-briefing designed to elicit the participants’ reflections upon the simulations and moderated as a focus group. Our study material included: field notes; the transcribed audio-recordings from 18 de-briefings and the transcript of a follow-up focus group held with local stakeholders.

Results: The analyses, bridging perspectives from ethnomethodology, conversation analysis and discourse analysis, revealed that participant reflections were dominated by language that objectified both the simulated patients and the participating professionals. When confronted with these findings, the local stakeholders expressed ambivalence about increasing the focus on the patient as a person when it was not of clear benefit to the patient and when it might impact negatively on “assessments and management” during the most critical phases.

Discussion: Despite these results, the dominant objectifying language may well suppress insights that patient participation could provide and which could potentially prove beneficial both to patients and professionals as persons, those who share the crisis in emergencies.

Conclusion: For future improvement, current emergency team trainings, characterised by increasing medical sophistication and professional competence, ought also to be enriched by increased focus on the role of the patient.

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