Patients undergoing dialysis as a model for medical students’ longitudinal engagement with chronic illness: Patient perspectives


  • Nicole Koehler Monash University, Eastern Health Clinical School Monash Centre for Scholarship in Health Education Deakin University
  • Erica Schmidt Monash University Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education
  • Matthew A Roberts Monash University, Eastern Health Clinical School Eastern Health
  • Jenepher Ann Martin Monash University, Eastern Health Clinical School Monash Centre for Scholarship in Health Education Deakin University Eastern Health



medical education, continuity of patient care, patient-centred care, chronic illness, longitudinal student/patient engagement, haemodialysis


Background: Medical students are predominantly exposed to patients with chronic conditions during acute episodes requiring hospitalisation. Consequently, this limits students’ opportunities to learn about continuity of patient care. Unlike hospitalised patients, patients undergoing haemodialysis attend dialysis clinics in ambulatory/outpatient settings multiple times per week over long time periods. Patients undergoing dialysis would be well placed to share their knowledge of their own chronic illness and their experience of patient-centred care. This study explored the willingness of patients undergoing haemodialysis to interact with the same medical student throughout the academic year. Methods: Twenty-seven patients undergoing dialysis at four dialysis units were interviewed.Results: Twenty-five patients indicated that they would be willing to regularly interact with students. Patients indicated that they would permit students to conduct a range of activities (e.g., taking a medical history). All 25 were willing to provide students with verbal feedback. Twelve were willing to provide written feedback. In terms of interacting with students, there were two predominant groups: 1) those who focus on the students’ needs and are prepared to interact with students frequently and over a long duration and 2) those who have had “enough” after a while and are prepared to interact with students over a shorter duration. Conclusions: Patients undergoing haemodialysis could provide students with opportunities to follow a patient’s journey, provided the length and frequency of the patient–student interaction is matched with patient preferences. 

Author Biographies

Nicole Koehler, Monash University, Eastern Health Clinical School Monash Centre for Scholarship in Health Education Deakin University

Senior LecturerMedical Education

Erica Schmidt, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Scholarship in Health Education

Senior LecturerStudent Academic Support Unit  

Matthew A Roberts, Monash University, Eastern Health Clinical School Eastern Health

Renal physician 

Jenepher Ann Martin, Monash University, Eastern Health Clinical School Monash Centre for Scholarship in Health Education Deakin University Eastern Health

Associate Professor Medical Education


ANZDATA: Australia & New Zealand Dialysis & Transplant Registry. (2019). Chapter 2: Prevalence of renal replacement therapy for end stage kidney disease. In ANZDATA 42nd annual report 2019 (Date to 2018).

Braunack-Mayer, A. J. (2001). Should medical students act as surrogate patients for each other? Medical Education, 35(7), 681–686.

Cribb, A., Owens, J., & Singh, G. (2017). Co-creating an expansive health care learning system. American Medical Association Journal of Ethics, 19(11), 1099–1105.

Davison, S. N., Levin, A., Moss, A. H., Jha, V., Brown, E. A., Brennan, F., Murtagh, F. E. M., Naicker, S., Germain, M. J., O'Donoghue, D. J., Morton, R. L., & Obrador, G. T. (2015). Executive summary of the KDIGO controversies conference on supportive care in chronic kidney disease: Developing a roadmap to improving quality care. Kidney International, 88(3), 447–459.

Gaufberg, E., Hirsh, D., Krupat, E., Ogur, B., Pelletier, S., Reiff, D., & Bor, D. (2014). Into the future: Patient-centredness endures in longitudinal integrated clerkship graduates. Medical Education, 48(6), 572–582.

Hirsh, D., Gaufberg, E., Ogur, B., Cohen, P., Krupat, E., Cox, M., Pelletier, S., & Bor, D. (2012). Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: A way forward for medical education. Academic Medicine, 87(5), 643–650.

Hudson, J. N., Knight, P. J., & Weston, K. M. (2012). Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: A qualitative study. BMC Family Practice, 13, Article 72.

Koehler, N., & McMenamin, C. (2013). Patients’ attitudes towards participating in clinical skills training purely for teaching purposes. International Journal of Clinical Skills, 7(2), 23–27.

Mol, S. S. L., Chen, H. C., Steerneman, A. H. M., de Groot, E., & Zwart, D. L. M. (2019). The feasibility of longitudinal patient contacts in a large medical school. Teaching and Learning in Medicine, 31(2), 178–185.

Norris, T. E., Schaad, D. C., DeWitt, D., Ogur, B., Hunt, D. D., & Consortium of Integrated Longitudinal Clerkships. (2009). Longitudinal integrated clerkships for medical students: An innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Academic Medicine, 84(7), 902–907.

Ogden, K., Barr, J., & Greenfield, D. (2017). Determining requirements for patient-centred care: A participatory concept mapping study. BMC Health Services Research, 17(1), Article 780.

Ogrinc, G., Mutha, S., & Irby, D. (2002). Evidence of longitudinal ambulatory care rotations: A review of the literature. Academic Medicine, 77(7), 688–693.

Ogur, B., & Hirsh, D. (2009). Learning through longitudinal patient care: Narratives from the Harvard Medical School–Cambridge integrated clerkship. Academic Medicine, 84(7), 844–850.

Poncelet, A., Bokser, S., Calton, B., Hauer, K. E., Kirsch, H., Jones, T., Lai, C. J., Mazotti, L., Shore, W., Teherani, A., Tong, L., Wamsley, M., & Robertson, P. (2011). Development of a longitudinal integrated clerkship at an academic medical center. Medical Education Online, 16(1), Article 5939.

Poncelet, A. N., Wamsley, M., Hauer, K. E., Lai, C., Becker, T., & O’Brien, B. (2013). Patient views of continuity relationships with medical students. Medical Teacher, 35(6), 465–471.

Poncelet, A. N., & Hudson, J. N. (2015). Student continuity with patients: A system delivery innovation to benefit patient care and learning (continuity patient benefit). Healthcare, 3(3), 607–618.

Rowland, P., Anderson, M., Kumagai, A. K., McMillan, S., Sandhu, V. K., & Langlois, S. (2019). Patient involvement in health professionals’ education: A meta-narrative review. Advances in Health Sciences Education Theory and Practice, 24(3), 595–617.

Teherani, A., Irby, D. M., & Loeser, H. (2013). Outcomes of different clerkship models: Longitudinal integrated, hybrid, and block. Academic Medicine, 88(1), 35–43.

Towle, A., & Godolphin, W. (2011). A meeting of experts: The emerging roles of non-professionals in the education of health professionals. Teaching in Higher Education, 16(5), 495–504.

Wamsley, M. A., Dubowitz, N., Kohli, P., Cooke, M., & O’Brien, B. C. (2009). Continuity in longitudinal out-patient attachment for year 3 medical students. Medical Education, 43(9), 895–906.

Wearn, A., & Vnuk, A. (2005). Medical students and peer physical examination: Two case studies of strategies to improve safety and increase acceptance. Focus on Health Professional Education: A Multi-Professional Journal, 7(2), 88–98.