BACKGROUND Patient-centredness is considered a core competency for health professionals. To support faculty in designing courses focused on patient-centredness, an understanding of how educational interventions lead to patient-centredness is required. This study aims to show how learning mechanisms, which potentially contribute to patient-centredness, are triggered. METHODS Thirty-five third-year medical students at the UMC Utrecht followed four different patients for two years. The intervention took place in an out-of-hospital setting. Students visited patients in their home circumstances and accompanied them to clinical events. Twelve students were interviewed. The realist approach was used to construct configurations which relate components of the intervention to the context and learning mechanisms. RESULTS Following patients in their home circumstances for a prolonged period supported the development of meaningful relationships between students and patients and provided continuity. In the context of a meaningful relationship and continuity, mechanisms contributing to learning patient-centredness were triggered. The most important learning mechanisms found in this study were: reflecting, contextualising disease in a real persons' life, broadening perspectives and engaging with the patients. CONCLUSIONS Learning mechanisms are triggered by continuity and by meaningful student-patient relationships. These can be enhanced by an out-of-hospital setting and longitudinal contact. Thus, a relationship between students and patients is an important enabler for the development of patient-centredness.

中文翻译：

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通过跟踪临床环境之外的患者来培养以患者为中心的方式：一项访谈研究。

背景技术以患者为中心被认为是卫生专业人员的核心能力。为了支持教师设计以患者为中心的课程，需要了解教育干预如何导致以患者为中心。这项研究旨在说明如何触发可能以患者为中心的学习机制。方法UMC乌得勒支大学的35名三年级医学生随访了4名不同的患者两年。干预在院外进行。学生在家中拜访患者，并陪同他们进行临床活动。采访了十二名学生。现实主义方法用于构造将干预的各个组成部分与情境和学习机制相关联的配置。结果长期跟随患者在家中的情况有助于学生与患者之间有意义的关系的发展，并提供了连续性。在有意义的关系和连续性的背景下，引发了以学习为中心的机制。在这项研究中发现的最重要的学习机制是：在真实的人的生活中反映疾病，将其情境化，扩大视野并与患者互动。结论学习机制是由连续性和有意义的学生与患者之间的关系触发的。这些可以通过院外环境和纵向接触来增强。因此，学生与患者之间的关系是发展以患者为中心的重要因素。