Context

Person-centeredness is a stated aim for medical education; however, studies suggest this is not being achieved. There is a gap in our understanding of how, why and in what circumstances medical education interventions that aim to develop person-centredness are successful.

Methods

A realist review was conducted with a search of Medline, Embase, HMIC, and ERIC databases and the grey literature using the terms “medical education” and “person-centred” and related synonyms. Studies which involved a planned educational intervention in medical education with data on outcomes related to person-centredness were included. The analysis focussed on how and why different educational strategies interact with biomedical learner perspectives to trigger mechanisms that may or may not lead to a change in perspective towards person-centredness.

Results

Sixty-one papers representing fifty-three interventions were included in the final synthesis. Nine context-intervention-mechanism-outcome (CIMOc) statements generated from the data synthesis make up our refined programme theory. Where educational interventions focussed on communication skills learning or experiences without person-centred theory, learners experienced dissonance with their biomedical perspective which they resolved by minimising the importance of the learning, resulting in perspective endurance. Where educational interventions applied person-centred theory to meaningful experiences and included support for sense-making, learners understood the relevance of person-centeredness and felt able to process their responses to learning, resulting in perspective transformation towards person-centredness.

Conclusion

Our findings offer explanations as to why communication skills-based interventions, may be insufficient to develop learners’ person-centredness. Integrating experiential person-centred learning with theory on why person-centredness matters to clinical practice and enabling learners to make sense of their responses to learning, may support perspective transformation towards person-centredness. Our findings offer programme and policy makers testable theory to inform the development of medical education strategies that aim to support person-centredness.