Family medicine interns’ experience conducting McGill illness narrative interview with non-compliant chronic patients

ABSTRACT Despite several governmental policies with the purpose of changing medical training in Brazil, it is still predominantly hospital-centered, and the learning process is focused on diseases. We conducted a study in a traditional medical school, in which the students carried out an interview focused on the illness experience assessing chronic patients with compliance difficulties in the treatment of hypertension and/or diabetes in primary care. Fourteen medical students during Family Medicine Internship at the Federal University of Rio de Janeiro were trained to carry out the McGill Illness Narrative Interview (MINI) and identify the modes of understanding and attribution of meaning to the illness and treatment experience. Before and after the completion of the set of 35 interviews, the students were listened to individually regarding their understanding of the compliance phenomenon and the experience with the MINI. The 35 interviews conducted by the students were analyzed with respect to the objectives of each section, in addition to interviewer’s general objective of offering a position of expertise to the patient in their report of the case. We sought to investigate the consistency of the student’s experience with this script to obtain the narrative of illness using the conceptual topics – prototypes and explanatory models – and the emerging topics identified according to the technique described by Bardin for content analysis. In the analysis of the interviews conducted by the researcher with the interns at the beginning and the end of the internship, the thematic analysis consisted of two main themes: clinical understanding and experience with the non-compliance phenomenon, and the appreciation of performing the MINI in the context of medical training. The students considered the MINI a useful tool for understanding and exploring the individuals’ illness and treatment experiences in their socioeconomic and cultural context. By recognizing the importance of the MINI, the interns usually reported few learning opportunities while providing care for patients. Although the students had previously recognized the importance of listening and the development of bonds, they did not know how these issues could be built, and the experience increased their confidence in the healthcare provided to patients in their medical daily life. The students noticed that non-compliance involved multiple factors, which did not usually emerge during regular medical appointments. In fact, there was more understanding about the compliance phenomenon.

摘要 尽管巴西已出台多项旨在改革医学培训的政府政策，但当前医学培训仍以医院为核心，学习过程亦围绕疾病展开。本研究于一所传统医学院校开展，由参与家庭医学实习的医学生针对基层医疗中高血压和/或糖尿病治疗依从性不佳的慢性病患者开展疾病体验访谈。共有14名在里约热内卢联邦大学参与家庭医学实习的医学生接受了McGill疾病叙事访谈（McGill Illness Narrative Interview，MINI）的实操培训，学习如何识别患者对疾病与治疗体验的理解模式及意义归因方式。在完成全部35份访谈的前后，研究人员分别对学生进行一对一访谈，以了解他们对治疗依从性现象的理解以及参与MINI实践的体验。研究人员针对学生完成的35份访谈内容，结合各访谈模块的研究目标，以及访谈者旨在让患者在病例报告中展现专业视角的核心目标展开分析。本研究旨在通过概念主题（原型与解释模型）以及依据巴尔丁（Bardin）内容分析技术所识别的新兴主题，探究学生遵循该访谈脚本获取疾病叙事过程中的体验一致性。针对实习初期与末期研究人员对实习生的访谈，主题分析涵盖两大核心主题：一是对治疗非依从性现象的临床认知与实践体验，二是在医学培训场景中开展MINI实践的感悟。参与学生均认为，MINI是一款能够帮助其在社会经济与文化背景下理解、探索患者疾病与治疗体验的实用工具。尽管实习生们此前已认可倾听与医患关系构建的重要性，但他们并不清楚该如何落实这些环节，而本次实践经历提升了他们在日常临床工作中为患者提供医疗服务的信心。学生们发现，治疗依从性不佳涉及多重因素，而这些因素在常规门诊中通常难以被察觉。事实上，通过本次实践，学生们对治疗依从性现象的认知更为深入。