The Patient Teacher in General Practice Training: Perspectives of Residents

Fostering Reflexivity in Medical Students: Is Patient Engagement a Promising Avenue? A Qualitative Case Study

Background

Reflexivity enables individuals to analyze a situation based on past experience to develop other ways of thinking and perspectives for action. Reflexivity is therefore crucial for the improvement of professional practice. In medical education, recent studies have identified patient engagement as a promising strategy for fostering reflexivity in students; however, few evaluative studies have explored such a link. This article describes the reflexive effects of an intervention that engages patients in small-group discussion workshops about ethical, moral, and social issues arising from practice (as part of an undergraduate medical course at Université Laval) and presents the main processes involved in producing these effects.

Methods

The study subscribes to a qualitative case study design. Cases are three groups that received the intervention in winter 2021. Data collection involved semi-structured interviews and non-participatory observation. Analysis entailed within-case and cross-case analysis. The study mobilizes Sandars' proposition of a three-stage reflexive process which is enhanced with other models of reflexivity.

Results

The main reflexive effects and processes involved: (i) better understanding disembodied theoretical content, (ii) awareness of the limits of the clinical view for grasping complex situations, (iii) questioning one's convictions about the self and the profession, and (iv) awareness of the patient-doctor social distance. When considering concrete implications for action, reflexive effects refer to a patient-centered approach, implying other ways of doing, being, and thinking as a physician.

Conclusions

This study was an opportunity to identify patient engagement in discussion workshops as a promising avenue to foster medical students' reflexivity and to better understand its whys and hows. It sheds new light on patient engagement's relevance and value in medical education. By identifying factors influencing the reflexive process, it also provides concrete support to medical schools wishing to commit to transformative educational postures and approaches involving patients.

Changes in French family medicine residents' perspectives about patient partners' participation in teaching: A qualitative study in co-facilitated practice exchange groups

PURPOSE

The patient partner in teaching method is progressively developing for clinical training in France. Practice exchange groups (PEG) co-facilitated by patient partners in teaching are used during the training of family medicine (FM) residents. This study explored the FM residents' perspectives about patient partner in teaching's participation in co-facilitated PEGs and how they changed over time.

STUDENTS AND METHODS

In 2020, qualitative focus groups were carried out with 26 FM residents before and after a 5-month intervention based on monthly PEGs co-facilitated by patient partners in teaching. A reflective thematic analysis of the focus group interviews was performed according to Braun and Clarke's approach.

RESULTS

FM residents supported patient partners in teaching's facilitation role and had high expectations concerning their contribution to the development of their skills and competencies. They expected patient partners in teaching to bring their individual experience and also a collective knowledge. Some limitations mentioned by FM residents disappeared over time, such as the loss of the medical group feeling among physicians, while others persisted and required pedagogical support targeted to FM residents before PEG initiation.

CONCLUSION

This study shows the good acceptance of patient partners in teaching by FM residents in the context of PEGs. Attention should be paid to make FM residents aware of patient partners in teaching's missions before their introduction.

Fostering the development of non-technical competencies in medical learners through patient engagement: a rapid review

Background

To train physicians who will respond to patients' evolving needs and expectations, medical schools must seek educational strategies to foster the development of non-technical competencies in students. This article aims to synthetize studies that focus on patient engagement in medical training as a promising strategy to foster the development of those competencies.

Methods

We conducted a rapid review of the literature to synthetize primary quantitative, qualitative and mixed studies (January 2000-January 2022) describing patient engagement interventions in medical education and reporting non-technical learning outcomes. Studies were extracted from Medline and ERIC. Two independent reviewers were involved in study selection and data extraction. A narrative synthesis of results was performed.

Results

Of the 3875 identified, 24 met the inclusion criteria and were retained. We found evidence of a range of non-technical educational outcomes (e. g. attitudinal changes, new knowledge and understanding). Studies also described various approaches regarding patient recruitment, preparation, and support and participation design (e.g., contact duration, learning environment, patient autonomy, and format). Some emerging practical suggestions are proposed.

Conclusion

Our results suggest that patient engagement in medical education can be a valuable means to foster a range of non-technical competencies, as well as formative and critical reflexivity. They also suggest conditions under which patient engagement practices can be more efficient in fostering non-instrumental patient roles in different educational contexts. This supports a plea for sensible and responsive interventional approaches.

Perspectives of patient educators about their participation in an interprofessional program for healthcare students and postgraduate medical students

Including patients in interprofessional education (IPE) programs adds value to healthcare students' education. However, little is known about the perspective and experience of the involved patient educators (PEs). An IPE program (Interprofessional Seminars, IPS) that includes PEs was developed in France in 2009. The aim of this study was to describe the PEs' perspectives about their involvement in IPS. Data were collected using semi-structured interviews with 32 experienced PEs, and analyzed using a reflexive thematic analysis in the framework of an inductive approach. PEs had an identifiable profile. They were motivated by a sense of civic service, had well-developed communication skills, and were prepared to share their experiential knowledge with students. They were concerned about their capacity to express themselves in front of students and the need to consolidate their involvement through a structured partnership that involves briefing, collaboration, remuneration, and feedback. They proposed to establish compulsory interprofessional training for all students and to strengthen the collaboration between an interprofessional group of students and a PE. Our results highlight the PEs' desire to be involved in IPE and to develop a genuine patient-student partnership. These insights should support the systematic integration of PEs in IPE.

Nomenclature of real patients in health professional education by role and engagement: a narrative literature review

Research problem

Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy.

Objective

Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement.

Methods

The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals.

Results

Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically.

Conclusion

Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.

[Integrating of patients as teachers in medical schools]

INTRODUCTION

In a social context supportive of patient engagement throughout society, many scientific claims are in favour of developing patient engagement in medical education. However, few studies have objectively investigated current practices and the obstacles to patient engagement from the point of view of medical educators.

PURPOSE OF RESEARCH

This study aimed at investigating medical educators' practices regarding patient engagement, and their expectations and self reported obstacles.

METHOD

This study's design was observational, cross-sectional and monocentered. Survey responses were queried by email from 565 academic medical educators at the Rennes Medical School in 2019. Patient engagement was ranked in four levels based on Pomey's theoretical frame, ranging from use of health data to cocreation of training programs.

RESULTS

The response rate was 23% (N = 128). The educator's profiles were diverse in age, specialty and status. 35 declared involving patients in their teachings, 4 of them declared cocreating courses with the patients. The remaining 93 educators did not involve patients in their course and reported some obstacles. The main obstacles were: never thought about it (60%), difficulties selecting the patient (36%) and lack of time (21%). The patient's role as a teacher was not disregarded.

CONCLUSIONS

This first study about academic educator's perspectives toward patient engagement in medical training identified obstacles and pathways to promote patient engagement.

[The roles of patients in healthcare provision, training and research: A French perspective]

In 2002, patients were transformed into users of the French health system. As this opinion piece demonstrates, in 2021 they may at least potentially participate more actively than before. They can convey their knowledge of a disease and its treatments, and voluntarily share their experience. They can intervene in user representation and therapeutic patient education, the objective being to increase the autonomy of one and all, patients and public, in the training of professionals, clinical research and evolution of the health system. The rationale for the involvement of patients and their roles in provision of care, training and clinical research are analyzed from a French perspective. The obstacles to overcome and improvements to be achieved are reviewed, the objective being to promote enhanced health democracy through increased patient engagement. In 2021, however, the role of patients in the design and implementation of therapeutic patient education (TPE) and in the development of medical studies curricula remains limited if not restricted; this is due not only to a lack of information, but also to the resistance of health professionals and universities. Patients could and should assume a major role, fostering evolution toward a more just and effective health care system.

[Impact of patient testimony in the education of medicine and pharmacy students]

The initiative from patients suffering from cancer or having had the disease in speaking about their illness to medical students during an internship in a cancer control center of the faculty of medicine and to pharmacy students at the university of Strasbourg was implemented in 2014. This action was coordinated by the French Cancer League as part of the National French cancer plan 3. After training, ten patients teachers were able to freely and spontaneously explain their diagnostic and therapeutic journey as well as their feelings about the disease and their relationship with their oncologists in front of 187 medical students and 131 pharmacy students. A moderator, often a former cancer teacher, helped coordinate the discussions. Questionnaires were given to students, patients teachers and moderators in order to assess the merits of the action and the expected benefits at the end of the training. A second questionnaire was sent to the students six months after the interviews. The assessment was made by an independent firm. The students' responses were very favorable and this training met their expectations in almost 98% of the cases and 1/3 of the students were destabilized by this training. Patients teacher were very satisfied with their intervention and felt that they were able to convey a message. Six months later, the 30% of student respondents said that these testimonies had or could have an impact on their practices. This is the first assessment of the interest of resource patients in teaching cancer patients about medical and pharmacy students.

Patient as teacher sessions contextualize learning, enhancing knowledge, communication, and participation of pharmacy students in the United Kingdom

PURPOSE

This study aimed to evaluate the impact of Patient As Teacher (PAT) sessions on the knowledge, communication skills, and participation of pharmacy students in the United Kingdom.

METHODS

During the academic year 2019-2020, year 1 and 2 pharmacy students at the University of Central Lancashire were invited to complete a questionnaire following PAT sessions. Data were analyzed by means of descriptive statistics, including mean and standard deviation (SD) for: continuous variables and reliability analysis. Pearson's Chi-Square or Fisher Exact Test, odds ratio, and Phi were used for analyzing dichotomous variables. Thematic analysis was used for free text comments.

RESULTS

Sixty eight of 228 students participated, (response rate of 29.8%). No statistical difference was found between gender (p=0.090); a statistically significant difference was found between year (p=0.008). Cronbach's alpha (0.809) confirmed a good internal consistency. 97.0% of the students learned a lot, and 85.3% appreciated and valued the PAT sessions; 89.7% wanted more sessions. 92.7% perceived the sessions to contextualize their learning. Five questions were dichotomized by grouping the responses into negative and positive; 90.3% of responses were positive and did not show statistically significant differences in gender and year of study. Overall students' free text comments were positive, but active listening and consultation appeared in the positive and negative domains, highlighting the need for more student engagement.

CONCLUSIONS

PAT sessions had a positive impact on students' knowledge, communication skills, and participation, and contextualized learning. They provide a valuable contribution to the pharmcy students' experience in the United Kingdom.