Possibilities for patient
involvement in medical education:
Lessons from Leicester
Professor Liz Anderson
Questions to ask ourselves
• Are there different perceptions on what
engagement means for patients/service users,
students and faculty staff?
• What does an authentic involvement mean for
patients/service users, students and faculty staff?
• What do students want?
Paracelsus certainly recognised the value….
‘….a good physician should be
ready to learn from
midwives, gypsies,
nomads, brigands and
others who live outside the
law. He should inquire
among all classes of
people, seeking out
everything that might
contribute to his
knowledge; he should
travel widely, undergo
many adventures, and
learn, learn the while.’
(Paracelsus, 1493- 1541)
Medical Education 1999;33:688-694
Results
Patients as teachers
(i) as experts in their condition
– showing managing disability
– clinical aspects etc.
(ii) as exemplars of their condition
(iii) as facilitators of the development of
professional skills and attitudes
Results
• How patients benefitted from participation
–
–
–
–
–
through talking
through learning about their condition
through learning about the training of doctors
by recognition of helping students' learning
by feeling useful in providing practical help to
students
– receipt of appreciative gifts
Medical Education 2010: 44: 64–74 doi:10.1111/j.1365-2923.2009.03530.x
Problems
• How to move beyond short projects
• Integration within Faculty
• On-going research required
– Impacts on patients; students; curriculum
Our Story
• Recognition that patients perspectives are
radically different from professionals
Inequalities in health
• 1995: ‘Health in the Community’
Stage 1. Immersion
Students meet patients and carers in
their care setting to listen to their
experiences of health and social care
and to explore their priorities.
Interprofessional groups range from 2 to
4 students. Each small group then
interviews all agencies caring for their
patient to analyse their roles and
responsibilities and priorities.
Stage 4. Feedback
Stage 2. Reflection
Student teams present their findings and
solutions and their recommendations to improve
care and care delivery
Debate and discussion lead to awareness of
gaps in service delivery and care. Solutions can
lead to changes as professional teams action
the highlighted shortfalls in provision. Managers
are in powerful positions to change and
overcome practice barriers.
Stage 3. Analysis
The student team consider all aspects
of the care package, including
constraints on service, unmet needs,
best practice to produce solutions to
identified problems. In particular they
compare patient and professional
priorities to look for a fit or mis-match.
They prepare a feedback to the
PHCT.
After each experience the student
teams reflect on what they have
learnt supported by facilitators.
They are encouraged to relate
profession specific theories and
policies to issues they identify.
Reflections enable students to
learn about each professional
domain.
Inequities in Health
• 1998: ‘Shaping our Future Medical
Workforce’ DOH- ‘Learning from Lives’
Disability
Social model of
disability
Teaching led by
disabled people
Leicester Centre for
Integrated Living
1998-2008
Anderson, ES. & Smith, R. (2010). Learning from Lives together: lessons from a joint learning experience for
.
medical and social work students. Health and Social Care in the Community,18(3), 229-240
What next?
• Patient involvement
– Steering groups
– Shaping teaching
– Available in their own homes
Next Steps:
• Partnerships to design new teaching
Research: Higher Education
Academy UK 2008-2011
Stage One: Move to integrated model
– Patients involved in the design of a teaching
event in which they support the teaching
Stage Two: Progress to empowerment
– Patients move on to take on leading roles in
teaching
Method
Exploratory Action Research Design;
• reflective problem solving
• collaborative
• takes place in the social learning context
• seeks to understand learning processes
‘to improve education by changing it and learning
from the process’
Kemmis & McTaggart 2005
Action Research Cycle: Stage One
Step 5:
Embed
Step 1:Planning
Steering group
Consultations
Step 4: Implement
changes
Pilots, n= 69 students,
additional, n=13 patients
Step 3: Reflection
Coffee morning wide patient
engagement
Step 2: Observing
Pilot with
n= 40 students and
n= 10 patients
The Patient Designed Learning
Away day: First Model
Students hear
service user
story
Students
discuss and
reflect
Student
recommendations
influence practice
Students
identify
improvements
Students take their
learning into practice
Interprofessional student groups have
conversations with two service users
Students and service
users discuss the key
messages for
professional practice
Students discuss what
they learned
Students present their learning in
accessible formats to the participating
service users and their peers
The “Listening Workshop”
22
Patients Comments
‘ I think this is a wonderful idea it should be compulsory before
anyone is let out there on “real” people. Practise on us, listen to
what we have to say then the same mistakes won' won’t be made’,
mother disabled child.
‘The whole experience of sitting down and talking to someone
who’s been through it is completely and utterly different to just
reading it in a book and more memorable because of it and will
be more useful I hope..’ disabled adult.
Patients Giving Feedback:
comment
‘It did leave you thinking what have I put on my
form and are they going to see it straight away?
But then I thought about what I had put on the
form and it was quite reasonable and that's OK.
But I could have been in a position where I
thought ‘Oh my God they are going to know
exactly what I thought of them’,
mother disabled child.
Student Comment
• Medical student
‘At medical school we are taught to take histories. The
patient story is regimented according to the doctor’ s
agenda. The Listening Workshop was therefore a
challenge. We were told to shut up and listen: less
questions, more attention and for the first time in a long
time I sat and listened to the patient’s story in the way they
wanted to tell it,’ focus groups extract.
NEXT STEPS: Stage Two
• Indications in early work of the desire and
ability of some patients to take on a leading
teaching roles.
– Annually 11 events, some 596 students.
• Second piece of research to consider what
a leading role might look like
Action Research Cycle: Stage Two
Step 5:
Final
Agreement
Step 1:Consultation
meeting
Coffee morning with patients
and educators
Step 4:
Step 2:
Focus Groups n=15
Patient workshop n=13
Student Focus groups n=25
Interviews: Patients n= 9
Staff n=3
Step 3: Consultation
meeting
Coffee morning wide patient
engagement
Patients Views
New Roles:
1.
2.
3.
4.
5.
6.
7.
Co-tutoring: helping to deliver the teaching
Recruiting: supporting new people as a mentor
Determining the curriculum
Organising support groups
Reading students work
Student selection
Confirm to employers who to select
New Roles
1. Co-tutoring: helping to deliver the
teaching
2. Recruiting: supporting new people as a
Mentor
Service user Comments
‘A good idea because otherwise you end up being a bit of a
specimen… whereas if you’re a co-tutor it kind of forces them
to listen to you more’.
‘I don’t think I personally want to be a co-tutor... I do think that
as a service user certain people have a huge amount to
offer… I am probably perfectly capable of doing it but its just
a confidence thing’.
‘I see myself mentoring…I’ve had enough experience doing
the workshops talking to students to be able to help other
people and advise them’.
Student Comments
‘It would be more helpful for us because any academic who
hasn’t themselves been in that position do not actually know
what the patients wants to tell’.
‘It would be very useful to back that up having patients teach
us because we are here to learn from them’.
‘You know it would possibly improve attendance because
you feel worse for letting down a patient who is taking their
time to do it’.
‘Our normal tutors are trained to be tutors.. They need to sign
our work… so I would rather have a tutor even if it was
supervisory’.
UNCERTAINTY
Do patients have the
authority?
This will change the
relationship. Will patients
have the skills?
Vulnerability of patients
VALIDITY
Yes with support; it’s their
right.
Social work students more
comfortable with the idea.
Would improve attendance.
This event ideal for
BALANCE
leadership
Student agenda
versus Service
user agenda
“two sides of the
coin
TEACHING
Teaching professionalism.
Support for patients needed.
Skills for this event.
Suggested methods of training
Full Report: March 2012
Anderson. ES., & Ford , J. (2012). Enabling Service
Users to Lead Interprofessional Workshops to
Improve Student Listening Skills. Higher Education
Mini Grant, Subject Centre, Medicine, Dentistry and
Veterinary Medicine. Project No: MP220. Newcastle.
http://www.medev.ac.uk/funding/7/22/funded/
Training Programme
New Roles Co-tutor & Mentor
Four training sessions
1.
2.
3.
4.
Common Induction: Adult Learning
Common Induction: Professionalism in teaching
Specific: Co-Tutor & Mentor
Specific: Co-Tutor & Mentor (practice)
Process: Shadowing, employment autumn 2012.
Patient Unit
• Agreement visions, payment scales,
• Involvements
– Teaching
– Student Support
– Student recruitment
Ladder of service user involvement
(Tew, Gell & Foster, 2004)
LEVEL 5
Partnership
LEVEL 4
Collaboration
LEVEL 3
Growing
Involvement
LEVEL 2
Limited Involvement
LEVEL 1
No involvement
Patients work together with teaching staff across
strategic and operational areas with an explicit
statement of partnership values. Patients with
secure contracts.
Patients as full time department members involved
as below in THREE major aspects of faculty work.
The department has a statement of values. Training
and supervision are offered.
Patients involved in TWO of the following:
planning, teaching delivery, student selection,
assessment, management or evaluation.
Payment at normal visiting lecturer rates.
Training and support offered.
Service users invited in to ‘tell their stories in a
designated slot. No opportunity to shape the course.
Payment offered.
Curriculum planned, delivered and managed with no
patient involvement.
In Summary
• Unanswered questions concerning the
‘professionalism’ of patients in medical
education
• Excellent and the reason for IPE
• Challenging, time consuming, worthwhile
Questions to ask ourselves
• Are there different perceptions on what
engagement means for patients/service users,
students and faculty staff?
• What does an authentic involvement mean for
patients/service users, students and faculty staff?
• What do students want?