title: Chronic patients in undergraduate education: didactic value as perceived by students.
abstract: OBJECTIVE
  Medical education should prepare students for future clinical practice. However, this preparation is inadequate for the most prevalent problem in health care: chronic disease. This applies to the continuous aspect of chronic disease. Within the context of a newly developed programme, we investigated what makes a chronic patient interesting in the eyes of medical students, what they learned from a specific programme in which each student had contact with a chronic patient 4 times in 8 months, and what they learned from their patients.
  
  
  METHODS
  A total of 240 Year 3 students were enrolled in the programme, 89 of whom filled in questionnaires at both the start and end of the programme. Topics included the characteristics of the ideal and the actual patient, the Ideal Physician Questionnaire, and several questions on the expected and actual amount of knowledge gained from the patient.
  
  
  RESULTS
  Students preferred patients who demonstrated clear symptoms and had frequent contacts with health care professionals during the programme to 'well adapted' patients. The perceived knowledge obtained from the patient was less than they had expected at the start of the programme. A didactic gain perceived as low was mainly due to low expectations of gaining knowledge at the start of the programme, a doctor-centred attitude and a high level of discrepancy between the student's ideal patient and the actual patient.
  
  
  CONCLUSIONS
  Programmes that aim to present chronic patients to medical students focus on patient selection so that patients who differ only very slightly from healthy persons are eliminated. In addition, realistic information on the types of patients with whom students can expect to have contact may help students appreciate the knowledge to be gained from these patients.
authors.affiliation: Faculty of Medicine, Maastricht University, Maastricht, The Netherlands. j.diederiks@zw.unimaas.nl
authors.forename: Joseph P M
authors.initials: JP
authors.lastname: Diederiks
authors.forename: Hans
authors.initials: H
authors.lastname: Bosma
authors.forename: Jacques T M
authors.initials: JT
authors.lastname: van Eijk
authors.forename: Marijke
authors.initials: M
authors.lastname: van Santen
authors.forename: Albert
authors.initials: A
authors.lastname: Scherpbier
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D010465:Perception; D013337:Students, Medical / Q000523:psychology*