Engaging patients as teachers of clinical interview skills

Patients and carers as teachers in psychiatric education: a literature review and discussion

INTRODUCTION

The direct involvement of patients and carers in psychiatric education is driven by policy in the United Kingdom and Ireland. The benefits of this involvement are well known, however, it is important to consider the ethical aspects. This paper suggests how further research could explore and potentially mitigate adverse outcomes.

METHOD

A literature search evaluating the role of patients and carer involvement in psychiatric education was undertaken to summarise existing evidence relating to the following: methods of involvement, evidence of usefulness, patient's/carer's views and learners' views.

RESULTS

The Medline search produced 231 articles of which 31 were included in the literature review based on the key themes addressed in the paper.

DISCUSSION/CONCLUSION

The available evidence is generally positive regarding the use of patients and carers in psychiatric education. However, available research is varied in approach and outcome with little information on the ethical consequences. More research is required to inform policies on teaching regarding potential adverse effects of service user involvement.

Involving service users and carers in psychiatric education: what do trainees think?

In 2004 the Royal College of Psychiatrists made it clear that it was committed to increasing the involvement of service users and carers throughout psychiatric education. This has been mandatory since June 2005 and it has been a compulsory aspect of psychiatric training for schemes to demonstrate a meaningful involvement of users and carers in the training of psychiatrists.

New Ways of Working and psychiatric trainees

This paper aims to consider postgraduate psychiatric training in the context of New Ways of Working for psychiatrists in England. It summarises the impact of recent changes in postgraduate training and the major training implications of New Ways of Working. Finally, it outlines some broad principles that need to be considered for training when implementing New Ways of Working locally.

Involving carers and service users in the training of psychiatrists

In June 2005 it became mandatory for psychiatric trainees to receive training directly from people who experience mental health problems and their carers. This will be checked on approval visits to all training schemes, and accreditation may be withheld until this aspect of training is in place. For many of those who are responsible for training, this may be a new undertaking. We outline some of the issues that trainers need to consider when involving service users and carers in their training programmes, including background issues, how to prepare both those delivering and those receiving training, and logistical considerations. It is hoped that this paper will alert trainers to issues that need to be considered if such training is to be successful.

Service user organisations: an untapped teaching resource

Aims and Method

To evaluate the introduction of service user-led teaching on experiences of psychiatric services and interview style into the educational programme of trainee psychiatrists. A ten-session programme was devised and delivered in conjunction with a local service user organisation. Twelve trainees underwent the training programme. Evaluation was undertaken through analysis of the feedback forms completed by the trainees.

Results

No significant difference was found between service user-led and psychiatrist-led sessions in content, relevance or presentation.

Clinical Implications

The study demonstrated that service user-led teaching can be integrated into a trainee's education programme without reducing the perceived quality or relevance of their education.

The MRCPsych post-2015: preparing trainees and improving courses

This article is aimed primarily at psychiatry trainees, MRCPsych course organisers, College tutors, educational supervisors and clinical supervisors. It describes recent changes to the MRCPsych curriculum and examinations and discusses the different approaches that educators can utilise to best help their trainees. We describe how the content of MRCPsych courses can help prepare trainees for both the written papers and the clinical assessment of skills and competencies (CASC). We discuss ways of incorporating patients and carers into course development, innovative approaches using technology to enhance learning, the role of workplace-based assessments and how international graduates may maximise their pass rate.

Patient and carer participation in old age psychiatry in England. Part II: models of participation

BACKGROUND

There are a number of models of patient and carer participation. Their usefulness and applicability to old age psychiatry is considered.

METHODS

Models of participation are reviewed and related to examples of participation initiatives drawn from the author's work in the context of the National Health Service in the United Kingdom.

RESULTS

Models of participation which emphasize collaboration and partnership are found to be useful. Simple interventions such as copying letters to patients and/or carers can lead to change in the balance of power between staff and patients/carers. Initiatives which draw on the experiences of patients and carers can facilitate organizational learning and development. Involving patients and carers in education offers a way to influence services and the staff working in them.

CONCLUSION

Participation is better understood as a spectrum rather than a hierarchy. Old age psychiatry services would benefit from developing greater patient and carer participation at all levels.

Patient and carer participation in old age psychiatry in England. Part I: a systemic perspective of the historical and policy context

BACKGROUND

Patient and carer participation in old age psychiatry is less developed than in other areas of mental health. What can we learn from the historical context about increasing participation and how can it be conceptualized?

METHODS

The historical and policy context of patient and carer participation in the National Health Service is reviewed and related to the development of old age psychiatry in England and the parallel development of the mental health user movement.

RESULTS

Systemic theory is offered as a way of understanding how partnership between healthcare professionals, patients and carers might lead to service evolution by bringing a range of perspectives together in order to co-construct a mutually influenced outcome. It is further suggested that this might empower not only patients and carers but also healthcare staff at a time when they are under increasing pressures.

CONCLUSIONS

Old age psychiatry patients and carers struggle to be heard but have much to offer to services in partnership with healthcare professionals as partners and allies in service development.

Service user involvement in undergraduate mental health nursing in New Zealand

This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skillful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.

Strategies and interventions for the involvement of real patients in medical education: a systematic review

OBJECTIVES

There is increasing emphasis on encouraging more active involvement of patients in medical education. This is based on the recognition of patients as 'experts' in their own medical conditions and may help to enhance student experiences of real-world medicine. This systematic review provides a summary of evidence for the role and effectiveness of real patient involvement in medical education.

METHODS

MEDLINE, EMBASE, ERIC, PsychINFO, Sociological Abstracts and CINAHL were searched from the start of the databases to July 2007. Three key journals and reference lists of existing reviews were also searched. Articles published in English and reporting primary empirical research on the involvement of real patients in medical education were included. The synthesis of findings is integrated by narrative structured in such a way to address the research questions.

RESULTS

A total of 47 articles were included in the review. The majority of studies reported patients in the role of teachers only; others described patient involvement in assessment or curriculum development or in combined roles. Patient involvement was recommended in order to bring the patient voice into education. There were several examples of how to recruit and train patients to perform an educational role. The effectiveness of patient involvement was measured by evaluation studies and reported improvements in skills.

CONCLUSIONS

There was limited evidence of the long-term effectiveness of patient involvement and issues of ethics, psychological impact and influence on education policy were poorly explored. Future studies should address these issues and should explore the practicalities of sustaining such educational programmes within medical schools.

Involving patients and their carers in educating and training practitioners

PURPOSE OF REVIEW

We summarize and discuss recent work that highlights the role of patients and carers in educating practitioners in the light of earlier findings.

RECENT FINDINGS

In today's National Health Services in the UK, a changing value base is emerging based on the participation of practitioners, patients and carers, with each group contributing to the education and training of healthcare professionals. The role of patients and carers in education is changing as the value of their experience and expertise is acknowledged. Now professionals are more actively recognizing that service users can contribute usefully to teaching in more unique ways, as 'experts' in their illness. They bring different perspectives and ways of thinking that can instill a new dimension to delivering healthcare services and training. Their expertise is defined by experience, and this different perspective gives them a unique role in teaching. They represent a potential teaching resource for medical education that is grossly underutilized.

SUMMARY

Patients and carers are experts in their particular circumstances and blending their expertise with that of professionals is likely to contribute to the best outcome in a particular situation. They are a valuable resource as potential teachers at all stages of medical education.