title: Pre-clinical patient contacts and the application of biomedical and clinical knowledge.
abstract: BACKGROUND
  Real-patient contacts in problem-based undergraduate medical education are promoted as a good way to introduce biomedical and (in)formal clinical knowledge early in the curriculum and thereby to foster the development of coherent and integrated knowledge networks. There are concerns, however, that such contacts may cause students to focus on clinical knowledge to the neglect of biomedical knowledge, and that group discussions may be dominated by teachers. We examined these concerns by addressing the following questions in the context of group sessions in which students prepare for and report on real-patient contacts. To what extent are biomedical and (in)formal clinical knowledge addressed? To what extent are these knowledge types addressed by students or tutors? Are connections made between biomedical and clinical knowledge?
  
  
  METHODS
  We videotaped and transcribed six preparation and six reporting group sessions (two preparation and two reporting phases for each of three groups) held with students in Year 3 of the problem-based curriculum at Maastricht University. During this year, real patients rather than paper patients are used. Qualitative analysis software was used to code propositions in the transcriptions in order to identify different kinds of knowledge and different functions of biomedical knowledge.
  
  
  RESULTS
  Formal clinical knowledge was the subject of 40.7% and 34.8% of propositions during the preparation and reporting phases, respectively. The corresponding percentages for biomedical knowledge were 15.0% and 28.0%. Tutors accounted for 63.4% of propositions during the preparation phase, and students for 80.1% during the reporting phase. Nearly all biomedical knowledge was related to clinical knowledge.
  
  
  CONCLUSIONS
  It appears that pre-clinical patient encounters can stimulate students to pay attention to both clinical and biomedical knowledge and to how they are connected. Tutor dominance was evident only during the preparation phase. Further research is needed to investigate whether pre-clinical patient contacts promote the development of coherent and integrated knowledge networks.
authors.affiliation: Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. A.Diemers@sk.unimaas.nl
authors.forename: Agnes D
authors.initials: AD
authors.lastname: Diemers
authors.forename: Margje W J
authors.initials: MW
authors.lastname: van de Wiel
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.forename: Erik
authors.initials: E
authors.lastname: Heineman
authors.forename: Diana H J M
authors.initials: DH
authors.lastname: Dolmans
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003479:Curriculum / Q000592:standards*; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D006801:Humans; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology; D010817:Physician-Patient Relations; D018794:Problem-Based Learning / Q000379:methods* / Q000592:standards; D012381:Role Playing; D013337:Students, Medical / Q000523:psychology*; D014743:Videotape Recording