Projects

ABSTRACT

Introduction:

The three-stage assessment, which includes clinical, individual, and contextual assessment, is a person-centred clinical method (biopsychosocial model). This method can help students and clinicians to assess biopsychosocial factors of the patient in a systematic way.

Aim and Objective of the Study:

To assess student performance of ‘three-stage assessment-patient centred care method’ using a rubric among students enrolled for fellowship in family medicine program.

Methodology:

It is a cross-sectional interventional study done at St John’s Medical College after obtaining ethical clearance among the students of the fellowship in family medicine program batch 2023–24 and 2024–25, a total of 80 students.

Results:

Overall assessment mean is 19.3263 (maximum score is 26) and SD is 3.5157. The mean for the clinical assessment (6.9236, SD 1.1465) is better than individual (5.8333, SD 1.5151) and contextual assessment (6.3819, SD 1.7492). The mean score for the management plan is 12 and SD is 2.2966 (maximum score is 16).

Conclusion:

Student’s performance of clinical assessment is better than individual and contextual (psychosocial) assessment and management. Overall performance of students on three-stage assessment is poor.

Keywords: Biopsychosocial model, performance, students, three-stage assessment

Introduction

Biopsychosocial model of assessment and care is well established and studied.[1] Usefulness of biopsychosocial model is well established in individualizing the care and improving the outcome of health care. Excellence can be found when we can individualize the assessment and management plan.[1,2] However, these models are not taught routinely in the medical education and are not in great use clinically, in the OPDs or in hospitals. The current medical education and clinical practice focus on biomedical model, focusing only on the illness and ignoring the person and comprehensive management plan.[1,2]

University of Medusa, Republic of South Africa, proposed a three-stage assessment, based on two articles published by Mc Whinny’s in 1969 on three-stage diagnosis and by Stott and Davis in 1979.[3] The three-stage assessment [Table A], which includes clinical, individual, and contextual assessment, is a person-centred clinical method (biopsychosocial model). This method can help students and clinicians to assess biopsychosocial factors of the patient in a systematic way.

Aim and objective of the study

To assess the performance of ‘three-stage assessment-patient centred care method’ using a rubric among students enrolled for fellowship in a family medicine program.

To assess the perception of students on ‘three-stage assessment method in patient centred management plan’

To assess the confidence of students in patient-centred approach using a confidence rating scale (retro-pre-test)

Methodology t is a cross-sectional descriptive interventional study done at St John’s Medical College after obtaining ethical clearance.

Study population: Students of the fellowship in family medicine program batch 2023–24 and 2024–25. A total of 80 students.

Inclusion criteria

Cases submission of three-stage assessment from the students of the fellowship in family medicine program batch 2023–24 and 2024–25.

Exclusion criteria: Incomplete case submissions.

Methods  Three-stage assessment clinical method was taught to fellowship students in the beginning of the course through the online session. The sessions covered a) need for the three-stage assessment, b) what exactly the method involves, c) how to implement it, and d) when to implement it. All these points were discussed using case scenarios. The relevant articles, PPT presentation, example case, and the template of the clinical method were shared with the students. Students were asked to apply this clinical method on two of their patients and present the finding in the template that was shared with them. After submission of the filled template, the perception of the students on their learning with the method and the confidence level on applying this method was assessed using a structured proforma. Methodology is described in the