EmergencyPedia

A Symposium Summary

This was a diverse AMEE session discussing patients and carers in medical education.

A central theme of this session was the question of how to move patients and carers from being an adjuvant in the learning process to the centre.

Here is a summary of the faculty presentations::

• Rob Lane (Leeds, UK) – who moderated the symposium and directed the conversation. Rob presented on behalf of a cystic fibrosis patient who educates in the UK. Some of the issues that were flagged by Andrea:
  • Assumption that she was well, because she ‘looked well’ (when she felt unwell)
  • Confidence is built by longitudinal relationship building between the ‘patient’ and ‘educators’

• Jools Symons (Leeds, UK) comes to the A.M.E.E. conference with 15 years experience of the AMEE conference.  Ms Symons as the widowed wife of a cancer patient with a 10-year journey through the National Health Service (NHS) – she advocated that students should work with patients as early as possible in their education.  Jools states it is important to bring the patient to the centre of learning.
  • Jools bravely used ‘@prezi’ for her presentation (j.e.symons@leeds.ac.uk)
• Jools suggests that there are some important issues to consider when patients are involved in medical education:

Jools Symons – “Don’t ‘use’ patients, work ‘with them’ please!“

• Working with patients allows them to feel empowered and share expertise
• Conversations between carer ‘mentors’ and students was found to be useful
• Giving the ‘patient community (sic)’ ownership helps them given 100% to the students.  At the Leeds program small gestures like badges helped with buy-in.
• Celebrate success to keep the program(s) sustainable – say thank you to the patients and carers with regular ‘events‘

Nancy McNaughton (Toronto, Canada) – an expert in ‘live‘ simulation and debriefing She has an interest in psychiatry.  She is interested in simulation in healthcare.

• Nancy spoke about honouring patient engagement in health professional education. In particular 3 projects (HIV patients, autism patients, Mental Health users)
• Take homes included:
  • Patient centred education can amplify communication skills and learner experience but needs to be facilitated in the correct way…
  • If not done well, it is very easy for the learning to move away from being ‘patient’ centered and become ‘student and teacher (medical expert)’ centred.
  • Co-creation of objectives and materials is becoming increasingly popular
  • Important within the story to have clear objectives and learnings from the story – rather than just the ‘patient story’ on its own…

Jane Moore (Oxford, UK) – gynaecology specialist leading O&G student education.  Dr Moore has pioneered work in allowing patients to teach doctors intimate examination.

• Jane spoke about how patients might fit into the assessment of medical students
• Take homes included:
  • Fitting patients in the assessment process is feasible from her experience
  • ‘Human factors’ – patients are not perfect, but neither are consultant examiners
  • For some time in Oxford lay women have taught the students intimate examination
  • Advantages when using the patients for assessment were that:
    • They knew the curriculum really well
    • Patient centred and experiential criteria were assessable
    • Technical skills (such as consent) were assessable
    • The students response to having patients as the examiner was interesting in that they questioned the ‘assessment’ given by the patient assessors The ongoing implementation of patients as ‘examiners’ required a lot of work as a result of this issue.
• Other areas of interest include talking to a person with hearing loss, professional use of e-mail (more challenging for the students than you might think) and discussing early pregnancy loss with patients.  They found that discussion miscarriage 20 times in a row was ‘too much’ so instead used their patient educators as ‘family members’
• One translational benefit of involving the patients in student assessment has been the amplification of the patients experience – and that being applied to clinical service improvements.
• A major challenge that we might face as we involve patients more is that we may be shocked about what patients actually want from their doctors – and it might force us to change what we do in medical education

• Katri Manninen (Stockholm, Sweden) – nurse background with a PhD.  She works in infectious diseases and directs educational programs for nurses.
• Katri spoke briefly about her experience with nursing students
• Take homes included:
  • Patient based learning success will depend on the quality of the interaction.
  • Ideally should be mutually positive experience and active learning for both student and patient.
  • The interaction with the patient should explore ‘meaning making’ and be conversational.

• Angela Towle and William Godolphin (BC, Canada) – gave a challenging oratory on culture change brought about by involving patients in education
• Angela and William spoke about mentorship (by patients), student’s professional identity and shared decision-making.
• Take homes included:
  • There are long-term benefits in involving patients (qualitative analysis 3-4 years after they had finished their program).
• Themes from their research included:
  • Viewing the patient as autonomous and an expert in their circumstances
  • Amplification of experience – students still remembered their learning experience 3 years after the event…

Post Presentation Discussion

• Concerns raised by the audience were that, while it made sense to fully involve the patient, that this concept is countercultural.
• Faculty suggested that bringing ‘patient centred learning’ into curricula is supported by the power of the experiences generated. Furthermore, students reflections are generally positive.  Faculty suggested local pilots in the first instance.
• Other challenges raised included the use of children (ethics) and a lack of evidence base for the concepts.