|Year : 2022 | Volume
| Issue : 3 | Page : 251-255
Advocating active and meaningful involvement of patients in the delivery of medical education
Saurabh RamBihariLal Shrivastava1, Prateek Saurabh Shrivastava2
1 Deputy Director – Academics, Sri Balaji Vidyapeeth – Deemed to be University, Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
|Date of Submission||12-Jun-2021|
|Date of Acceptance||25-Aug-2021|
|Date of Web Publication||27-Dec-2022|
Dr. Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, M.Phil. (HPE). Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
The onus of knowledge acquisition and learning has demonstrated a paradigm shift in the field of medical education. The present review has been carried out to explore and understand the role of patient involvement in the training of medical students. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 26 articles were selected based on the suitability with the current review objectives. The involvement of patients in medical education has been linked with a wide range of proven benefits and learning progression. The patients can discharge multiple roles, namely a teacher, developing curriculum, assessor, and someone who can select students for the course. The role of actively involving patients in the teaching process is bound to have some challenges and barriers considering the different aspects in heterogeneous settings. The ideal approach to involve patients in medical education has to start with sensitizing the faculty members and the medical students about the benefits that can be derived out of such clinical interactions. The successful implementation will essentially require adequate resource support and faculty involvement. To conclude, the patient involvement in medical training is not a new practice, but the ground reality is that we are falling short to optimize the benefits of the overall practice. The need of the hour is to adopt a systematic approach and structure the overall program, so that we can derive tangible benefits out of the same and prepare the future generation of doctors in the delivery of patient-centered care.
Keywords: Educators, medical education, patient, patient involvement, teachers
|How to cite this article:|
Shrivastava SR, Shrivastava PS. Advocating active and meaningful involvement of patients in the delivery of medical education. J Sci Soc 2022;49:251-5
| Introduction|| |
The onus of knowledge acquisition and learning has demonstrated a paradigm shift from being teacher-centric in the traditional mode to student-centric in the competency-based medical education. However, considering the width, the breadth of the knowledge, skills, values to be mastered, and the complexities of the medical branch itself, within the defined training period, it will be best to adopt a shared approach. The shared approach is something like wherein the teachers, the students, the administrators, the patients, the parents, the members of the community, all are considered accountable to ensure effective learning and thereby meeting the vision of producing a competent medical graduate., The present review has been carried out to explore and understand the role of patient involvement in the training of medical students.
| Methods|| |
An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on patient involvement in medical education published in the period of 2000–2021 were included in the review. A total of 29 studies similar to current study objectives was identified initially, of which, 3 were excluded due to the unavailability of the complete version of the articles. Overall, 26 articles were selected based on the suitability with the current review objectives and analyzed. Keywords used in the search include patient, patient involvement, teachers, educators, and medical education in the title alone only (viz., patient [ti] AND medical education [ti]; patient [ti] AND students [ti]; patients [ti] AND medical students [ti]; patients [ti] AND educators [ti]; patients [ti] AND teachers [ti]). All the articles published in the English language were only selected for the review [Figure 1]. The collected information is presented under the following subheadings, namely Patients in medical education, Justification for patient involvement, Areas of patient involvement, Selection of patient teachers, Training of patient teachers, Teamwork: Faculty members and patient teachers, Patients' perspective about the process: Pros, Patients' perspective about the process: Cons, Challenges in patient involvement, Strategies to ensure better implementation and overcome concerns and challenges, Lessons from the field, Implications for practice and Implications for research.
| Patients in Medical Education|| |
In the last couple of decades, patients have been involved as a part of curriculum delivery in heterogeneous settings.,,, In this proposed curricular reform, we must understand that the role of patients is not limited just as learning material required for clinical training. In fact, the medical educators have realized the significance of patients in the overall process and therefore in many of the medical institutions, every student is allocated a family that they are supposed to follow-up throughout their training period. This practice plays an important role in getting oriented with the local community cultures and traditions, development of social and communication skills and gives them an authentic exposure about illness and individual in community settings.,,
| Justification for Patient Involvement|| |
The involvement of patients in medical education has been linked with a wide range of proven benefits and learning progression. These merits include training of students from the perspective of patients, exposure to inter-professional care, leadership role, being socially accountable, and eventually the empowerment of the patient and their family members.,, In addition, the students understand the need to follow-up in case of lifestyle disorders and the management of complications. Thus, the overall teaching-learning becomes more inclusive, engaging, and transformative as the students realize their roles and responsibilities in improving the health care delivery system and the health workforce.,,
| Areas of Patient Involvement|| |
The patient in the field of medical education can discharge multiple roles, namely a teacher, developing curriculum, assessor, and someone who can select students for the course.,,, In their capacity as a teacher, they can help the students in developing their skills pertaining to history taking, physical examination, counseling, sharing experiences, provision of feedback, and mentoring., While discharging their role as curriculum developers, patients can help in the development of curriculum pertaining to specific topics of local relevance, evaluation of the overall course, and identification of the potential competencies for the students., In addition, the patients can act as a bridging agent between the health system and community leaders and even strengthen community-based learning.,
As assessors, patients can deliver constructive feedback to the students about their performance and can also play their part in summative assessments (like in an objective structured clinical examinations)., In settings, wherein the medical students are selected keeping in mind the fact that upon completion of the training, they should serve for the upliftment of the local community, the patients can assess the potential candidates for their compassion, empathy, communication skills, and thus aid the authorities in the enrollment process.,, Overall, patients should be looked on as equal partners in the act of training, assessment, and curriculum development.,,, The patients can be involved either in authentic ward or outpatient settings or as simulated subjects.
| Selection of Patient Teachers|| |
The patients can be enrolled in the curriculum delivery either using the linkages of the community medicine department in the field practice area or based on the advertisements done in different media. Another approach for recruitment can be through using the community organizations or with the help of a local practitioner or with the help of existing patients who are already part of the system.,,, The standard approach will be to develop a set of criteria for the enrollment of patients and interview the potential participants for their inclination toward teaching, communication skills, time that can be dedicated, desire to learn in the process and readiness to be subjected to repeated history elicitation or clinical examination.,,,,
| Training of Patient Teachers|| |
However, the selected patients cannot be directly involved in the process of teaching, assessment, or curriculum development., They have to be sensitized about their roles and responsibilities by means of a training program organized by the educational experts. It is important to orient the selected patient teachers about the goal of the overall course and ways in which the patients can be involved in meeting the specific learning objectives.,, The training program should also target toward developing their confidence, the ways in which they can deliver effective feedback to the students about their performance, and some kind of orientation about the overall educational process. Further, we must expose these selected patient teachers about dealing with potential conflicts and emotions by explaining them about the mentoring and coaching.,,
| Teamwork: Faculty Members and Patient Teachers|| |
We must realize that mere selection and training of the patient teachers will not guarantee the delivery of the desired results. As a matter of fact, there has to be a constant supervision and guidance from the side of faculty members for the learning objectives that need to be targeted in any session, wherein patients are involved as teachers.,,, The teaching sessions can be either in the form of patients working under the supervision of a faculty member or they both work together as a team. The faculty members can prime the students about the session and extend support to the patient teachers so that they are actively involved without any apprehensions.,, Even in case of assessments, the faculty member can sensitize the patients about what all domains they should observe among students while they are performing and the ways in which inputs can be given to the students for improved performance in future encounters.,,,,
| Patients' Perspective about the Process: Pros|| |
A wide range of positive and negative views was reported in the literature, justifying the need to properly plan and support the patients during the process so they can be more positive about their contribution.,, On the positive note, the literature revealed that these patient teachers or assessors expressed personal satisfaction owing to the worthwhile contribution they were able to make by improving the confidence of the students, helping them to enhance their skills, and thereby in more than one way discharge their responsibility toward strengthening of the health system and improvement in the quality of health indices of the community in the long run.,
The patients were also quite happy to be the part of the educational training and assessment process owing to the material benefits (such as free laboratory investigations, better management of their own illnesses both because of the improved understanding of their disease as well as proximity with the medical teachers), personal benefits (in terms of better knowledge about medical conditions) and emotional benefits (such as the satisfaction to be a part of training to help the humankind, emotional bonding with the students).,,,,
| Patients' Perspective about the Process: Cons|| |
On the negative note, there were various forms of apprehensions like being reluctant to share personal details to a significant number of students, being subjected to stigmatization (especially in cases of sexually transmitted infections or other personal issues), and not so positive reaction from the students., Toward the start of their involvement, a significant number of studies have revealed that the selected patient teachers or assessors were quite anxious and nervous about their role. Some of the studies even reported that it was mentally traumatizing for them to repeatedly share their stories with the patients, and they were significantly drained out emotionally., Further, any personal issues at family level also impacted their ability to discharge their roles effectively in teaching.
| Challenges in Patient Involvement|| |
The role of actively involving patients in the teaching process is bound to have some challenges and barriers considering the different aspects in heterogeneous settings.,,,,,, These challenges include traumatic experiences by the students after interaction with the patient teachers that can be overwhelming for the students. The students even reported that a patient assessor might not be competent enough to distinguish between a good, average, and poor performance., This even accounted for the lack of preparation on the students' part, just because they were quite certain that patient teachers do not have much role in summative assessments. In fact, concerns were even raised with regard to the quality of feedback given by the patient teachers, considering the lack of medical knowledge among them.,,
Obviously, the outcome of the patient involvement will depend a lot on the type of patient who has been selected, their training status and their willingness to be a part of the educational process even after multiple interactions with different batches of students.,, Further, in those settings, wherein patients themselves plan and engage the students, we cannot be really sure about the student learning and the impact of the same. Moreover, if we start involving the same patient for different clinical encounters, it does not add much to the learning of the students. Finally, we have to give due consideration toward the financial implications (arising because of the remuneration or reimbursement of expenditures, training organization) and the cost-effectiveness of the overall process.,,,,
| Strategies to Ensure Better Implementation and Overcome Concerns and Challenges|| |
The ideal approach to involve patients in medical education has to start with sensitizing the faculty members and the medical students about the benefits that can be derived out of such clinical interactions.,,, In order to enhance their acceptance levels, it will be a good practice to showcase the positive experiences of the universities that have delivered encouraging results., On a similar note, the process of selection of patients has to be also sound one, wherein we do give emphasis toward their desire to teach and be a part of the training process enthusiastically. It is always nice to look for the presence of an existing framework of patient and public relations department, so that the process of coordination with patients can be streamlined.,
The successful implementation will essentially require adequate resource support and faculty involvement (in terms of proper guidance and supervision)., The involved patient teachers can be periodically sensitized, encouraged, and appreciated about their roles and the ways they can further improve on to avoid saturation and burnout. The support extended by the faculty members, administrators, patient organizers, and existing patient teachers can take care of the nervousness and anxiety expected at the start of their involvement. As far as the fact that interactions with patient teachers can be an emotionally draining experience, the students can be debriefed after the session and also encouraged to reflect on in terms of learning.,,, Moreover, to enhance the effectiveness of the sessions, faculty members and patients should work as a team keeping the learning objectives in mind. Further, we should aim to create a cohort of such patients, each one specific for a particular disease or condition to avoid ambiguity and using the same patient for different conditions.,,
| Lessons from the Field|| |
At Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed-to-be-University, specific steps have been taken to actively involve patients in the delivery of medical education. In order to benefit students, the institution has initiated standardized patient initiative for the training of students in the second professional year. Prior to this, the faculty members have been trained in a sensitization program-cum-workshop organized by the Medical Education Unit of the institution. The sensitization program-oriented the faculty members about the overall benefits, the process of selection of patients, the training of selected patients, the ways in which they can be involved, and the preparation of case scripts.
Subsequently, the department of community medicine was involved in the process of selection of patients, wherein a structured schedule was used to interview the patients and eventually the candidates were selected depending on the eligibility criteria. Simultaneously, four departments, namely general medicine, general surgery, community medicine and obstetrics and gynecology were given the responsibility to prepare 2 case transcripts each in both English and the local language (Tamil). These prepared transcripts were reviewed by a panel of experts and based on the suggestions given, the scripts were modified. This was followed by the training of the selected candidates and making them aware about the roles in the process of training and the art of giving feedback.
The students of the second professional year while they were posted in above-mentioned 4 departments, were given exposure to these standardized patients on fixed days, and after the exposure, the feedback from both parties was obtained. The students and standardized patients both found the approach interesting and useful as both the parties had many things to learn from each other. The Medical Education Unit, the Department of Community Medicine, the Standardized Patient Coordinator from the Department of Otorhinolaryngology, along with the public relationship officer played important roles in the successful planning and implementation of the initiative.
| Implications for Practice|| |
Although considerable evidence is available to support the fact that for encouraging patient outcomes, patients and doctors should share responsibility and work as a team, a lot needs to be explored pertaining to how to introduce and integrate within the existing teaching–learning and assessment process. However, as the need of the hour is to deliver patient-centered care, there is an indispensable need to systematically involve patients in all stages of medical education. The introduction of patient involvement in teaching–learning will obviously require administrative support, as it involves financial investments. The Medical Education Unit has to be actively involved in the process of capacity-building workshops and the patient representatives for fostering liaisons with the potential patients. Further, for the seamless implementation of the initiative, it will be ideal that both faculty members and patients understand their role and supplement each other with a solitary aim of benefiting students.
| Implications for Research|| |
As the active involvement of patients in a different capacity in medical colleges is still in the nascent stages in most of the settings, there is an immense scope for strengthening research activities. The proposed research can start right from identifying the settings where patients can be involved and the learning objectives they can fulfill. Subsequently, research can be conducted to identify the pros and cons of patient involvement in the medical training. Even though quantitative research can deliver promising findings, but it will be ideal to conduct either a mixed-methods study or a qualitative study to explore the views of both students as well as patients. Based on the research findings, remedial measures can be taken to improve the existing practice and make it even better for the subsequent batches of students. Furthermore, research activities can also target the cost-effectiveness of the overall initiative, so that specific measures can be taken to ensure its sustainability.
| Conclusion|| |
Patient involvement in medical training is not a new practice, but the ground reality is that we are falling short to optimize the benefits of the overall practice. The need of the hour is to adopt a systematic approach and structure the overall program, so that we can derive tangible benefits out of the same and prepare the future generation of doctors in the delivery of patient-centered care.
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Conflicts of interest
There are no conflicts of interest.
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