Table 3.

Themes with representative quotes from medical student experiences that were least patient-centred

	Year 1/2 Medical students	Year 3/4 Medical students
Negative role modelling	Ignore patient concerns ‘Although he never asks the patients about anything besides symptoms … one patient brought up out of the blue that she was stressed about the fact that her husband was in the end stages of lung cancer. My preceptor’s response was to continue asking about side effects from an antibiotic.’ Failure to include the patient in team discussion or teaching ‘My longitudinal clerkship (LC) preceptor frequently talked to me about the patient while the patient was in the room, as if the patient were not in the room.’ Lapses in professionalism ‘When I am in the hospital (shadowing, on a rotation, etc.), I often overhear nurses, residents, and/or attendings make distasteful comments about patients or families who are difficult to work with. Sometimes … within earshot of the patients and families.’	Ignore patient or other providers’ concerns ‘Medical professionals ignoring patients’ own words or nodding and seeming to agree when the patient is speaking, but then proposing a different plan of action without acknowledging the patient’s wishes for something different’ ‘Attending kind of side-stepped patients concerns and passed the buck off to her medical oncologist rather than take the time to explain things.’ Lapses in professionalism ‘13 year old girl came in to paediatric ED with increased vaginal bleeding, was uncomfortable seeing me (as a male) and requested a female provider … 2 female PAs were available; the attending, laughed, said she would have to be punished and wait for 20 mins for refusing to talk with me and said to the patient should get over it, she was just having a period. PAs and attending then continued to online shop for 20 mins before one of the PAs went to see the patient.’
Students discouraged from being patient-centred	Regarding the social history ‘The physicians chosen for Preceptor Skills repeatedly told me that Social History is a waste of time and docked my write-up every time I had that section.’ Discounting idealism ‘Basically every lecture where physicians tell us about how one day we will get out of the false pretences of medical school and into the ‘real world’ of medicine.’	Spend as little time as possible with patients ‘Multiple instances on surgery when I was encouraged to spend less than 3 min with the patients if at all possible.’
Other factors	Objectification ‘Anatomy was horrible. The instructors saw the cadavers as pieces of objects instead of real, dead people. I was disturbed.’ In time-sensitive situations, attention to a patient’s background, story, or social history is limited ‘Some of my LC experiences have been severely time limited such that I have been forced to ask only “medically relevant” questions that completely forgo engaging the patient as more than a diagnosis.’	Objectification ‘Patients were discussed by disease with many negative comments about their BMI.’ ‘Patients became fractures and operations; there was very little interaction with patients (the most interaction was waking the patient up at 4:45 AM to make sure he/she could wiggle his/her toes).’