Service user involvement in radiotherapy and oncology education; the patient perspective

A scoping review of patients as partners in undergraduate allied health curriculum: How are they involved?

INTRODUCTION

Patient participation in undergraduate education has been proven to contribute to student skills development complementing their didactic training. An increasing number of educational programs have implemented systematic patient engagement in curriculum to comply with the requirements of professional and regulatory bodies and to ensure greater focus on patient care. This scoping review aims to identify and summarize literature on the integration of patients and associated benefits in undergraduate allied health education programs.

METHODS

This scoping review was conducted using a comprehensive literature search of the electronic databases MEDLINE, EMBASE and CINAHL. The study was carried out and reported using the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidance for Systematic reviews and Meta Analyses. Inclusion criteria included English language and allied health education. Exclusion criteria were outside the date range of 2011 to 2023, non-allied health programs, and clinical exposure during didactic courses. Literature reviews and commentaries were also excluded.

RESULTS

A total of nineteen studies were included in the scoping review. The majority of these papers examined undergraduate programs that engaged patients in curriculum delivery while a few involved patients in feedback delivery and formal assessment. Other forms of patient involvement were through curriculum co-design. Across institutions, evidence suggested the benefits of patient involvement to students, patients, and educational programs for improved delivery of person-centred care.

CONCLUSION

Patient involvement in curriculum delivery and student assessment provided valuable teaching and learning experiences for students and patients. Patient engagement also ensured that person-centered care principles were integrated into education programs. Summary of findings are provided to better prepare patients and facilitators for their role and to enhance the benefits to all participants.

Lived experiences of healthcare. Putting the person in person centred care in the medical radiation sciences

INTRODUCTION

Contemporary healthcare models recognise person-centred care (PCC) as a fundamental principle of quality, safe care. While substantial literature exists on PCC in healthcare generally, there is less evidence on how this relates to medical imaging and radiation therapy. Embedding patient-lived experiences of healthcare into healthcare education has promise in enhancing students' confidence in delivering PCC. Digital storytelling (DST) of patient-lived experiences can help improve reflection, understanding, critical thinking and empathy.

METHODS

Authentic patient-lived experiences were extracted from students' clinical workbooks, transformed into first person vignettes and integrated into the curriculum. Students were invited to attend focus groups to explore the impact the activity had on the student.

RESULTS

Thematic analysis identified three themes. (1) Enhancing PCC; (2) Mode of Delivery (Scaffolded Learning); and (3) Collaborative Learning. PCC was the strongest theme with students stating this is the first time they engaged in an activity focused on the psychosocial aspect of patient care. The majority of students indicated the mode of delivery was engaging and unique, whereby the vignettes were presented incrementally. Collaborative learning was identified by over half of the students where learning took place in a safe and supportive environment.

CONCLUSION

This project explored students' perspectives of integrating patient-lived experiences into the curriculum via DST. Students who engaged with the activities felt better prepared to deliver quality safe PCC.

IMPLICATIONS FOR PRACTICE

Providing healthcare students with opportunities to develop skills to deliver PCC before they enter the workforce can enhance their confidence in delivering effective PCC.

Post-traumatic stress symptoms, post-traumatic stress disorder, and post-traumatic growth among cancer survivors: a systematic scoping review of interventions

The detrimental effects of Post-Traumatic Stress Symptoms (PTSS) and Post-Traumatic Stress Disorder (PTSD) and the benefits of Post-Traumatic Growth (PTG) are well established for cancer survivors. Increased cancer survival rates necessitate an understanding of how these two paradoxical outcomes, PTSS/PTSD and PTG, are targeted through interventions. This systematic scoping review aims to (a) examine existing evidence on interventions targeting PTSS/PTSD and/or PTG among cancer survivors and (b) identify knowledge gaps to inform future research. Following the six steps of a scoping review, 76 articles met the inclusion criteria. Quantitative articles were examined using descriptive analysis. Frequency counts of the collated data were tabulated into summary tables. Qualitative articles were reviewed using meta-synthesis. Most articles were quantitative (n = 52) and targeted PTG (n = 68) through promising intervention approaches such as psychotherapy, mindfulness, physical activity, and psilocybin-assisted therapy. Three key implications for future research and practice were synthesized: (1) mechanistic considerations for intervention design that provide a roadmap for rigorous and theoretically-grounded research; (2) the need for improved representation of cancer survivors in trials; and (3) potential facilitators of intervention efficacy. Together, these findings can direct future research to optimize interventions to reduce PTSS/PTSD and promote PTG achievement among cancer survivors.

Patients' perspectives on their motivations for participating in non-clinical medical teaching and what they gain from their experience: a qualitative study informed by critical theory

In 2019-2021, we engaged in a project aimed at developing, implementing, and evaluating an educational intervention actively involving patient-teachers in undergraduate medical education at Université Laval, Quebec, Canada. Patient-teachers were invited to participate in small group discussion workshops during which medical students deliberate on legal, ethical, and moral issues arising from medical practice. Patients were expected to bring other perspectives, based on their experience with illness and the healthcare system. Little is still known about patients' perspectives on their participation experience in such context. Informed by critical theory, our qualitative study aims to document,: (i) the motivating factors for patients' participation in our intervention; and (ii) what patients gained from the experience. Data collection was based on 10 semi-structured interviews with patient-teachers. A thematic analysis was conducted using NVivo software. Motivators for participation arose from: (i) perceived consistency between patients' individual characteristics and those of the project, and (ii) conceiving the project as a means to reach individual and social goals. What patients gained mainly refers to (1) the appreciation of a positive, enriching, motivating yet uncomfortable and destabilizing experience; (2) a deconstruction of biases against the medical field and critical thinking about their own experience; (3) new knowledge, with a potential impact on their future interactions with the healthcare system. Results reveal patients as non-neutral thinking and knowing subjects, engaged in the participation experience as active teachers and learners. They also highlight the empowering and emancipatory nature of the learning gained through patients' participation experience. These conclusions prompt us to promote transformative interventional approaches that question the pervasive power issues in medical teaching and value patients' specific knowledge in teaching and learning the Art of Medicine.

An exploration of communication skills development for student diagnostic radiographers using simulation-based training with a standardised patient: UK-based focus-group study

INTRODUCTION

Communication is an essential skill for all healthcare professionals but is particularly challenging for diagnostic radiographers since their role involves conveying extensive information within a relatively short amount of time. One method to develop communication skills in radiography is through simulation-based training using high fidelity simulation activities. The use of video recording for reflection and debriefing are also important elements that can be utilised to enhance learning. The aim of this project was to explore student radiographers' experiences of a simulation-based activity utilising a standardised patient designed to aid development of communication skills.

METHODS

Fifty-two undergraduate 3rd year diagnostic radiography students at a single Higher Education Institution undertook a simulation roleplay exercise with an expert by experience (EBE) who acted in an anxious manner in order to challenge the student's communication skills following the simulation, students received a debrief session where detailed feedback was provided from the EBE and an academic. Students were also able to watch their video of the simulation and reflect. Students were invited to participate in a focus group to discuss their experience and the learning they had developed and 12 students participated. Transcribed material from the focus groups was thematically analysed to deduce themes of learning developed and ways to improve for future simulations.

FINDINGS

Six main themes were identified from the thematic analysis of the transcripts from 12 diagnostic radiography students. These were patient care, radiographer's role and responsibilities, personal development, feelings, fidelity, and pedagogy. The themes represented the key learning points expressed by students and also aspects of the simulation which could be improved. Overall, the simulation provided a positive learning experience for the students. Having a video recording of the scenario was regarded as beneficial to enable a depth of reflection on non-verbal communication skills, which would be beneficial in future simulation scenarios. Students were aware that even though they used appropriate language their overall manner affected the interaction with the expert by experience more significantly. Students also considered methods to improve their communication if they encountered a similar patient interaction in their future practice.

CONCLUSION

There is great potential for simulation-based training in developing communication skills for diagnostic radiography students. EBEs are a vital addition to simulation and educational activities in Higher Education Institutions and should be involved with the design of simulation activities also, as they can bring unique patient insight.

Importance of Incorporating the Perspectives of People with Cancer into Oncology Education: A Scoping Review

Background

With the shift towards person-centered care (PCC) in oncology, there is a need for parallel evolution of oncology education programs to prepare the next generation of health professionals to deliver effective PCC. These programs should be designed utilizing perspectives from individuals who have lived experience with cancer to ensure that changes to education curricula translate to improved PCC in the clinic.

Objectives

Our goal was to identify existing literature describing such programs as well as identify gaps for further development.

Methods

Keywords were agreed upon and searched across Ovid Medline, Ovid Embase, ERIC, Google Scholar, and MedEdPORTAL databases. Duplicates were removed, unique articles were screened for relevance by title and abstract, and a full text review of each article was completed for validation. Included articles describe methods for involving people with cancer in developing and/or delivering oncology-focused education programs.

Results

In total, 15 articles describing 12 unique oncology education programs from 7 different countries were identified, reviewed, and summarized. These programs involved learners undertaking undergraduate medical education, postgraduate medical education, continuing medical education, or training as nurses or radiation therapists. Current literature indicates that classroom-based sessions, experiential or simulated learning modalities, and/or asynchronous online modules can all feasibly be created with the integration of perspectives/narratives of people with cancer. Furthermore, involving people with cancer directly in the design and/or delivery of these education programs may contribute to improved patient experiences.

Conclusions

Including the perspectives of people with cancer directly in oncology curriculum development and delivery can improve established pedagogical approaches and enhance learner confidence and competency in delivering PCC. We provide recommendations for stepwise implementation of patient perspectives into oncology education, with the hope that future programs will better prepare and motivate learners to provide PCC aimed at improving cancer care, quality of life, and disease outcomes.

They are a different breed aren't they? Exploring how experts by experience influence students through mental health education

Experts by Experience (EBE) in mental health are increasingly becoming involved in the education of health professionals. In response, research findings suggest positive attitudinal change towards people who experience mental distress and enhanced appreciation of recovery and person-centred approaches to practice. However, this growing body of evidence has not resulted in the broad adoption of these roles in academia. The perspectives of academics instrumental in implementing academic positions for EBE (referred to as allies) have not yet been articulated. Acknowledging this gap, the aim of this research was to explore experiences of allies involved in implementing EBE positions in academia regarding the impact of EBE led education on students. Qualitative exploratory methods were used involving in-depth interviews with allies. Data were analysed thematically. Participants observed significant positive impacts on students, as evidenced through four themes: contextualized learning, enhancing reflection, feedback from the clinical field, and students' own lived experience. The fifth sub-theme, Challenging experiences were observed to potentially detract from the student experience in some instances. Overall, participants were very supportive of EBE involvement and were confident this approach produced more person-centred and recovery-oriented clinicians, with the skills, knowledge and attitudes needed to work as practitioners. These findings support previous research and suggest positive implications for clinical practice and for students with their own mental health challenges.

International audit of simulation use in pre-registration medical radiation science training

INTRODUCTION

Simulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions.

METHODS

An anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks.

RESULTS

A total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources.

CONCLUSION

SBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision.

IMPLICATIONS FOR PRACTICE

Increased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.

Learning From Cancer Survivors as Standardized Patients: Radiation Therapy Students' Perspective

INTRODUCTION/BACKGROUND

Healthcare programs have proven the benefits of standardized patients in educational activities, but limited scholarship exists on the involvement of cancer survivors in radiation therapy education. This innovative approach to simulation-based education in radiation therapy is the first to integrate cancer survivors as standardized patients in a high-fidelity environment. This research aims to examine the impact of cancer survivors on the students' learning during their simulation course.

METHODS

This qualitative research used a phenomenological approach to gather data and analyze the students' view of their interactions with cancer survivors in the simulation course. The researchers conducted three focus group discussions with five of the eight radiation therapy students using a set of preformulated questions.

RESULTS

The collected data were comparatively analyzed, and the research team identified four main themes: experience, teaching/coaching, patient-centeredness and gratitude. These represented the students' perspective on their experiences and the unique learning opportunities provided by the cancer survivors.

FINDINGS/DISCUSSION

The simulation activities with the cancer survivors provided a safe and realistic experience for the students. This research highlighted the influence of the cancer survivors' oncology journey on the skills development of the radiation therapy students.

CONCLUSION

The students benefited from the authentic patient perspective of the cancer survivors which helped build their confidence and develop their skills prior to clinical placement. This research demonstrated that incorporating cancer survivors as standardized patients in radiation therapy simulation education has added significant value to the students' learning.

Helping Others: Reasons for Participation in Service User Involvement Initiatives from the Perspective of Adolescents and Young Adults with Cancer

Purpose: Service user involvement, which implies involvement in decision-making processes important for organizing, developing, and evaluating health care, is sparsely investigated from the perspective of adolescents and young adults (AYAs) with cancer. Thus, the purpose of this qualitative study was to investigate AYAs' reasons for participation in service user involvement initiatives during their cancer course. Methods: Data from 12 semistructured interviews with AYA cancer patients and AYA cancer survivors aged 16-29 years were analyzed using thematic analysis. The participants had been involved in one or more service user involvement initiatives in "Kræftværket," a youth support center and social organization for AYAs with cancer in Copenhagen, Denmark. Results: Four main themes with matching subthemes were identified: Community (Being together, Developing together, and In the same boat), Normality (A new normal and Something to do), Contribution (Something at heart, Support to other AYAs, and Improving the health care system), and Codetermination (Real participation and Influence on one's own everyday life). Conclusion: Participating in service user involvement initiatives had a positive impact on the illness course of AYAs with cancer as the participation recreated a feeling of normality, codetermination of one's own everyday life, and met a wish for altruism in terms of helping others.