Patient Perception of Medical Student Engagement in Community- Based Outreach Activities During Community Health Clerkship: A Q-Methodology Study


Introduction The essence of the medical profession is providing service not only to individual patients but to the community at large. The patient-physician inter-action is essential in the Community Service learning component of the Doctor of Medicine curriculum of the University of Santo Tomas, Faculty of Medicine and Surgery (UST-FMS) students for more than fi ve de-cades. As the modern view of the patient veers away from paternalism, however, he assumes the roles of ‘member of the health team,’ an ‘evaluator of care,’and a potential ‘agent of change.’ Evidence-based guidelines on health promotion in adult patients recommend giving them “voice” and involving them in projects. A blank spot exists regarding attitudes and expectations of adult patients about the role of medi-cal students in community-based projects, as these re-main unreported. Anchored on the Community-based Program Theory, this paper explores the central ques-tion: How do patients perceive the role of medical students in a community-based setting?

Methodology The Q-methodology is the primary design used in this study. It combines the objectivity of quantitative approach with the essence of human experiences as explored in qualitative studies. The participants (P-sample) were 25 subjects gathered by convenience sampling in a community outreach site of the Department of Preventive, Family, and Community Medicine of the UST-FMS, in a compre-hensive Philippine University. They were asked to ar-range 25 statements (Q-sample), derived from the initial interview, in the Q-sort table based on their degree of agreement, which was then further expli-cated in the post-sort interviews. The results were then subjected to by-person factor analysis with vari-max rotation using the PQ Method version 2.11.

Results and Discussion Four profi les emerged from the by-person factor analysis, i.e., the respon-dents value the medical students in their various roles in the community as: (1) ‘community engager’ in a curative role; (2) ‘capacity enhancer’ in a promotive role; (3) ‘community enabler’ in a preventive role; and (4) ‘community energizer’ in a rehabilitative role. The discussion focused on similarities and differences among profi les regarding the three principal themes (attention, appreciation, and action) derived from the statements used as the Q-sample. This paper con-tributes to primary care research, as it 1) applied a mixed-method approach in the study of patient and physician relationship in the Philippine community setting; 2) knowledge and perceptions of Filipino pa-tients were codifi ed and made explicit through this study; and 3) it adds to the worldview of the culture-laden concept of patient-physician relationship, par-ticularly regarding the Filipino patients’ perceptions of the medical student as a primary care physician and the role they play in his/her healthcare.

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