Parents-as-teachers: design and establishment of a training programme for paediatric residents

Educational programmes for paediatric healthcare professionals in patient- and family-centred care. A scoping review

To identify and describe educational programmes in patient- and family-centred care for paediatric healthcare professionals. This scoping review was conducted and reported according to the JBI Manual for Evidence Synthesis and the PRISMA guideline. The databases searched included MEDLINE (PubMed), PsycINFO, CINAHL, Scopus, Cochrane, and Embase. Inclusion criteria were experimental, observational and qualitative studies about educational programmes on patient- and family-centred care for paediatric healthcare professionals. Exclusion criteria were reviews and non-peer-reviewed literature. Two reviewers independently screened and extracted the data using Covidence. Of the 13922 records identified, 49 articles met the inclusion criteria. There was a large variety of educational programmes, half of which were interdisciplinary, that mainly targeted nurses and doctors. The median number of participants was 51 (range 7 to 1411). The predominant target population was children with chronic disabilities and neonatal intensive care units, and only one programme specifically targeted adolescents. The median duration was one day (range 5 min to 3.5 years). Development of competencies was the most common objective. We identified 12 different educational content areas. Content mainly focused on communication and relational competencies, including partnership, which involved shared decision-making, mutual agenda setting, and negotiation of a plan. Many kinds of educational strategies were found but experiential learning through simulation and roleplay was used most.   Conclusion: A large variety of educational programmes in paediatric patient- and family-centred care exist. Educational content mainly focused on communication and relational competencies. Experiential learning including roleplay and simulation was the most used educational strategy. What is Known: • Delivery of patient- and family-centred care improves parental satisfaction of care but requires clinicians have a certain attitude towards involving the child and parents in a healthcare partnership as well as advanced triadic communication skills. Little is known about how this attitude, and more broadly, patient- and family-centred care, can be facilitated through education and training. What is New: • This scoping review found a wide array of programmes.. Workshops with simulation or roleplay was the most frequent educational strategy. The programmes, which typically targeted nurses and doctors, chiefly focused on basic and advanced communication and relational competencies, including partnership, which involved shared decision-making and negotiation of plans.

Patient references in the 2005 and 2015 CanMEDS frameworks

Background

Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks.

Methods

We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks.

Results

Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME.

Conclusion

There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

To Connect and Educate: Why Families Engage in Family-Professional Partnership Training Experiences

Successful family-professional partnerships (FPP) have been shown to positively impact both satisfaction with care and health outcomes for children with disabilities and their families. Many healthcare training programs have recognized the benefit of FPP training and often include learning experiences that feature families as teachers or mentors. However, most research on FPP training has focused on professionals' experiences, and not on families' experience in the roles of mentors and experts. The Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program is a graduate-level interdisciplinary training program with sites across the country. LEND programs train future healthcare and service professionals in the disability field and often utilize a Family Mentor Experience (FME) as one aspect of their training. This study used qualitative interviews to examine the experiences of eight family mentors who worked with trainees in one LEND program. Overall, the family mentors expressed positive views regarding the FME, describing how it allowed them to connect with trainees, other families, and community resources, as well as educating trainees. Family mentors also identified several facilitators and barriers to participation. Study findings provide information on the FFP's impact on family mentors and guidance on how programs can support sustainable, effective FPP experiences.

Effect of a patient-led educational session on pre-clerkship students' learning of professional values and on their professional development

BACKGROUND

While there are several curricula using patients as educators, little has been published on how they affect student learning and professional development.

OBJECTIVE

To explore what 1^st year medical students learn about professional values from a patient-led educational experience and how it affects their professional development.

DESIGN

We piloted a pediatric patient and family-led educational session during the molecular medicine course, with the goal of sharing the experience of caring for a child with a chronic illness. Following the session, students were required to submit a written reflection on what they learned and the impact the session had on them. All reflections from one academic year were qualitatively analyzed by two investigators and organized using HyperRESEARCH software. A content analysis approach was used to generate codes and emergent themes. Two theoretical lenses guided the analyses: Arnold's framework on professional values and the lens of professional identity formation, described as a process by which health care professionals "think, act and feel like a physician.

RESULTS

Students gained an appreciation of professional values, especially humanism and excellence, and how clinician role models reinforce these values. Reflective writings demonstrated recognition among learners that their identity involved being active participants in health care delivery and not just as passive classroom learners. Students were motivated to study diligently and be patient advocates; some questioned their skills in dealing with ambiguity and with the health-care system, resulting in a sense of helplessness.

CONCLUSION

Students learn the importance of professional attributes and of clinician role models through a pediatric family teaching experience. They are motivated, displaying glimpses of their future role as caregivers and patient advocates; however, some also express fear and doubt their own abilities. Based on this, a debriefing session has been introduced to prevent a negative effect on learner self-efficacy.

Training Medical Professionals to Work with Patients with Neurodevelopmental Disorders: A Systematic Review

Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders.  Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes.  Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders.  Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.

Enhancing Empathy in Medical Students: Family-Faculty Members Facilitate Patient-Centered Reflection

Parents of children with medical complexity can serve as family-faculty in undergraduate medical education. Medical students can learn about family-centered care through structured interviews, reflective writing, and classroom discussions with family-faculty.

Evolving Motivations: Patients' and Caregivers' Perceptions About Seeking Myotonic Dystrophy (DM1) and Huntington's Disease Care

Patient-centered care provision is challenging under ideal circumstances; myotonic dystrophy (DM1) and Huntington's disease (HD) are examples of chronic, progressive health conditions that may challenge its limits. If we can understand how care unfolds in these conditions, health care providers may be better equipped to address patients' needs. Constructivist grounded theory informed data collection and analysis. Fourteen patients with DM1 or HD, and 10 caregivers participated in semistructured interviews. Constant comparative analysis was used to identify themes. Participants attended clinic to seek expert information and social support. Medical management, altruism, and support provided the motivation. However, motivations evolved, with clinic becoming more important for caregivers as patients deteriorated. Clinic was conceptualized as a "safe space" to actively participate in health care and research. In the absence of disease-halting or curative treatments, participants perceived that they derived a therapeutic benefit from seeking care and from engaging in education and advocacy.

Integrating Family as a Discipline by Providing Parent Led Curricula: Impact on LEND Trainees' Leadership Competency

Background While the MCH Leadership Competencies and family as a discipline have been required elements of Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs for over a decade, little research has been published on the efficacy of either programmatic component in the development of the next generation of leaders who can advocate and care for Maternal and Child Health (MCH) populations. Objective To test the effectiveness of integrating the family discipline through implementation of parent led curricula on trainees' content knowledge, skills, and leadership development in family-centered care, according to the MCH Leadership Competencies. Methods One hundred and two long-term (≥ 300 h) LEND trainees completed a clinical and leadership training program which featured intensive parent led curricula supported by a full-time family faculty member. Trainees rated themselves on the five Basic and Advanced skill items that comprise MCH Leadership Competency 8: Family-centered Care at the beginning and conclusion of their LEND traineeship. Results When compared to their initial scores, trainees rated themselves significantly higher across all family-centered leadership competency items at the completion of their LEND traineeship. Conclusions The intentional engagement of a full-time family faculty member and parent led curricula that include didactic and experiential components are associated with greater identification and adoption by trainees of family-centered attitudes, skills, and practices. However, the use of the MCH Leadership Competencies as a quantifiable measure of program evaluation, particularly leadership development, is limited.

Long-term pediatrician outcomes of a parent led curriculum in developmental disabilities

Previous research has demonstrated high satisfaction and perceived relevance of Project DOCC (Delivery of Chronic Care), a parent led curriculum in developmental disabilities, across a sample of medical residents.

AIMS

The influence of such a training program on the clinical practices and professional activities of these residents once they are established in their careers as physicians, however, has not been studied; this was the aim of the present study.

METHODS

An anonymous follow-up survey was designed and disseminated to physicians who participated in Project DOCC during their one-month developmental disabilities rotation as part of their pediatrics or medicine/pediatric residency between 2002 and 2010. Fifty-eight physicians completed the survey.

RESULTS

The findings suggest that participation in a parent led curriculum during medical residency had a lasting impact on physicians' relationships with families. Specifically, a majority of the physicians espoused a family-centered approach to care, a sensitivity to the interactional effect that caring for a Child with Special Health Care Needs (CSHCN) has on family members, the need for physicians to have a prominent role in community resource coordination, and the importance of an integrated approach to health care provision.

CONCLUSIONS

Use of a parent led curriculum as a means to increase the provision of family-centered care by physicians is supported.

Challenges and potential solutions to educating learners about pediatric complex care

OBJECTIVE

To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators.

METHODS

Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education. Data were analyzed using grounded theory.

RESULTS

Of the 15 participants, 9 (60%) were in educational leadership positions. All participants provided care to children with medical complexity (CMC), although 80% (n = 12) reported no formal training. Thematic analysis revealed learners' challenges in 2 domains: 1) a lack of ownership for the patient because of decreased continuity, decision-making authority, and autonomy, as a result of the multitude of care providers and parents' distrust; and 2) a sense of being overwhelmed as a result of lack of preparedness and disruptions in work flow. Participants suggested 3 mitigating strategies: being candid about the difficulties of complex care, discussing the social mandate to care for CMC, and cultivating humility among learners.

CONCLUSIONS

Residency education must prepare pediatricians to care for all children, regardless of disease. Training in complex care involves redefining the physician's role so that they are better equipped to participate in collaboration, empathy and advocacy with CMC. This study is the first to identify specific challenges and offer potential solutions to help establish training guidelines.

Identifying what pediatric residents are taught about children and youth with special health care needs and the medical home

OBJECTIVE

To describe what and how pediatric residents in Massachusetts are taught about children and youth with special health care needs (CYSHCN) and the medical home.

PARTICIPANTS AND METHODS

Faculty members and residents at Massachusetts' 5 pediatric residency programs were interviewed to identify current curricula and teaching methods related to care of CYSHCN. In addition, residents were surveyed to quantify these concepts.

RESULTS

Thirty-one faculty members and 25 residents were interviewed. Most exposure to CYSHCN was reported to occur in inpatient settings. However, most formal teaching about CYSHCN was described as occurring in the ambulatory setting. Promising educational strategies included home and community visits, inclusion of CYSHCN in resident continuity panels, and simulation and role-playing. Overall, the programs had little training emphasis on the lives and needs of CYSHCN and their families outside the hospital setting. Twenty (80%) of the residents interviewed completed the written survey instrument. They noted a high degree of comfort in caring for CYSHCN in various settings and involving families in decision-making about their child's care but expressed less comfort in identifying community resources and collaborating with community agencies and schools.

CONCLUSIONS

Programs offer a variety of successful educational and clinical experiences related to the medical home and CYSHCN. The results of our study indicate that residents and faculty members believe that residents would benefit from more formal training opportunities to learn directly from families and community representatives about caring for CYSHCN.

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.

Do patients have an obligation to participate in student teaching?

CONTEXT

Patients may participate in teaching in many ways, in different settings and with different degrees of expert supervision. The majority of patients are generally very willing to participate in teaching. At times, however, patients may decline to see students because they are too sick, wish to maintain their privacy, prefer to have more expert care, or simply wish to have no involvement with students. This raises the question as to whether patients have any obligation to participate in education.

METHODS

A number of arguments are advanced to justify the claim that patients have an obligation to participate in student teaching. These include: that patients should participate in training for the benefit of others if they wish to benefit from the care of those who have learnt from others; that, without patient participation in teaching, the entire health system would collapse; that participation in education provides a benefit over and above the provision of individual care; that, as we all benefit from the presence of a functioning health system, we should all be prepared to contribute to it, and that patients should 'pay' for free public health care by participating in teaching.

CONCLUSIONS

None of the arguments that patients have an obligation to participate in medical education are convincing. We believe that patients participate in training largely out of altruism rather than obligation. Where possible, sick patients should be substituted for by healthy patients or simulations.

"User involvement is a sine qua non, almost, in medical education": learning with rather than just about health and social care service users

Despite the General Medical Council emphasising the value of service users to medical students' education, there is scant literature about service user involvement in medical education. Although some research has outlined the effectiveness of service users as teachers, none has explored social issues surrounding how medical students learn 'with' rather than just 'about' service users. Incorporating insights from contemporary socio-cultural learning theory, this study examines the views and experiences of 47 stakeholders (comprising 19 service users, 13 medical students and 15 medical educators) concerning service user involvement in medical education. Eight audiotaped focus group discussions were convened and the audiotapes were transcribed. The transcripts and audiotapes were independently analysed by multiple researchers using Framework analysis. Seven content- and five process-orientated themes emerged from the analysis. Content-related themes included the costs and benefits of service user involvement in medical education and process-related themes included the use and function of humour and metaphor. In this paper, we focus primarily on the content-related themes. We discuss these findings in light of the existing service user involvement literature and contemporary socio-cultural learning theory and provide implications for further research and educational practice. We encourage educators to involve service users in medical education but only in a considered way.

Using the Ages and Stages Questionnaire to teach medical students developmental assessment: a descriptive analysis

BACKGROUND

After a survey of medical graduates' skills found a lack of confidence in developmental assessment, a program was introduced with the broad aims of increasing medical student confidence and respect for the parents' role in childhood developmental assessment. Research has shown that parents' concerns are as accurate as quality screening tests in assessing development, so the program utilised the Ages and Stages Questionnaire, a parent completed, child development assessment tool.

METHOD

To evaluate the program, an interpretative analysis was completed on the students' reports written during the program and a questionnaire was administered to the parents to gain their perception of the experience. As well, student confidence levels in assessing growth and development were measured at the end of the paediatric term.

RESULTS

Although there was an increase in student confidence in developmental assessment at the end of the term, it was not statistically significant. However the findings indicated that students gained increased understanding of the process and enhanced recognition of the parental role, and the study suggested there was increased confidence in some students. Parents indicated that they thought they should be involved in the teaching of students.

CONCLUSION

The ASQ was shown to have been useful in an education program at the level of advanced beginners in developmental assessment.

People with HIV as educators of health professionals

This qualitative study examined the impact upon people living with HIV (PHAs), of being trained and utilized as educators of health professionals. PHAs participated in a training program to help them develop skills to facilitate learners in problem-based educational events. After training the PHAs participated in small group problem-based tutorials with separate groups of physiotherapy and occupational therapy students and family medicine residents. Content analyses of the PHAs' reflective journals and semistructured interviews conducted at completion of the project indicated there was a positive impact on their teaching skills, self-awareness, personal understanding of HIV, confidence in teaching, and everyday life. Learner feedback indicated that they valued their interactions with the PHAs. This model of education has the potential to positively benefit patients living with a variety of illnesses and disabilities.

"Contact A Family": professionals and parents in partnership

This paper considers the evidence base on the role of parent organisations in meeting the needs of parents of disabled children for information and support. Having a disabled child is a major cause of stress and has an impact on the health and wellbeing of the entire family. Current concepts of stress and coping are used to consider coping strategies, including the search for information, the desire to stay in control, and the quest for social support. How and when information and support are provided will impact on how well the family adjust and cope.

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.

Addressing transition to adult health care for adolescents with special health care needs

OBJECTIVE

To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs.

METHODS

Data for 4332 adolescents, 14 to 17 years of age, from the 2000-2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model.

RESULTS

Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship.

CONCLUSIONS

Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training

BACKGROUND

The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors.

METHODS

The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop.

RESULTS

The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants.

CONCLUSIONS

The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme - both trainers and trainees will be essential.

Participating in medical education: views of patients and carers living in deprived communities

OBJECTIVES

Active patient involvement in community-based education is still relatively novel; in particular, the involvement of patients living in socially and economically deprived areas is still unusual. This study explores the views of patients and carers living in deprived areas on their participation in medical education.

DESIGN

A total of 36 patients and 18 parents were interviewed at home by Year 1 students undertaking an accelerated 4-year degree programme. Subsequently, taped interviews using a topic guide were carried out with 18 patients/carers. Their views on their active involvement with medical students are presented here.

RESULTS

Most of the patients in this study did not view themselves as teaching the students but considered their role to be more one of partnership, explanation and sharing. They considered that they were the 'best judges' of certain aspects of their illness. These aspects related to psychological, social and behavioural issues, which impacted on both themselves and their families. Patients considered these issues to be as important as the medical condition they were diagnosed with. Patients also raised issues concerning the importance of doctors listening to patients.

CONCLUSION

This study showed that patients living in areas of deprivation were positive about being involved in medical education. They considered their personal experience and knowledge of illness to be an important aspect of student learning. They were happy to share this knowledge and they were very keen that doctors should listen to them. The challenge for medical educators is to ensure that this is achieved.

Developing the role of patients as teachers: literature review

OBJECTIVES

To identify the roles and settings in which patients participate as teachers in medical education and the benefits to learners, their educational institutions, and participating patients.

DESIGN

Review of publications from 1970 to October 2001 providing descriptions, evaluations, or research of programmes involving patients as teachers in medical education.

DATA SOURCES

1848 references were identified from various electronic databases. Applying inclusion criteria to abstracts generated 100 articles, from which 23 were selected after independent scrutiny.

RESULTS

13 articles discussed the role of patients in teaching physical examination skills, mostly musculoskeletal examination. Patients also taught pelvic and male genitorectal examination skills. Teaching roles varied, and 19 articles referred to patients' involvement as assessors. 18 articles described patients' training, with some patients being assessed. Reports of learners' experiences were all positive, many valuing the insights and confidence gained from practising skills on patients in a teaching role. Some learners preferred being taught by trained patients rather than doctors. Patients who were consulted enjoyed their teaching role. Several articles commented on the high quality of patients' teaching. Remuneration varied from payment of expenses to an hourly rate. Motivation for recruiting patients included the desire to reduce costs and the value attributed to the consumers' perspective.

CONCLUSION

Involving patients as teachers has important educational benefits for learners. Patients offer unique qualities that can enhance the acquisition of skills and change attitudes towards patients.

Patient-oriented learning: a review of the role of the patient in the education of medical students

AIM

To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research.

METHODS

Literature review.

RESULTS

Direct contact with patients can be seen to play a crucial role in the development of clinical reasoning, communication skills, professional attitudes and empathy. It also motivates through promoting relevance and providing context. Few studies have explored this area, including effects on the patients themselves, although there are examples of good practice in promoting more active participation.

CONCLUSION

The Cambridge framework is a tool for evaluating the involvement of patients in the educational process, which could be used by curriculum planners and teachers to review and monitor the extent to which patients are actively involved. Areas for further research include looking at the 'added value' of using real, as opposed to simulated, patients; more work on outcomes for patients (other than satisfaction); the role of real patients in assessment; and the strengths and weaknesses of different models of patient involvement.