Key constructs of success | Key constructs of failure | |
---|---|---|
Health care delivery | •Collaborative working practices | •Repeated/prolonged hospital admissions |
•Holistic and transparent goals developed through negotiation | •Clinician reluctance to look beyond biomedical markers | |
•Integration of medical and experiential knowledge regarding diseases and impact | •Negative corollaries of the described constructs of success [1,13,24,26,37,44,57,61-65] | |
•Professional sharing of best practice | ||
•Transformative learning through trusted relationships between patients and practitioners to enable self-management [1,10,12,24,26-28,37,44-48,51,52,57,61,63-69] | ||
Experiential learning in workplaces | •Learning to engage in and benefiting from collaborative working | •Contexts which reduced students and patients to passive roles |
•Reciprocal learning: viewing learning as a shared social process | •Negative workplace cultures | |
•Learning from direct interaction with patients | •Lack of exposure to multimorbidity with excessive focus on single-disease frameworks | |
•A supportive environment for the appropriate mix of responsibility, challenge and scaffolding to permit a safe but legitimate role in practice | •Overreliance on guidelines often not developed on evidence applicable to patients with multimorbidity in primary care [27,28,50,65] | |
•Physical space to allow interactions between patients and trainees | ||
•Patients and practitioners needed to learn how to make personalised trade-offs between risks and benefits in multimorbidity and to manage competing priorities which could change over time [10-12,26,27,47,48,50-53,56-59,64,68-75] |