Involving patients in medical education

Building a Cancer Care Clinic for Transgender and Gender Diverse Individuals

Transgender and gender diverse (TGD) people experience disparities in cancer care, including more late-stage diagnoses, worse cancer-related outcomes, and an increased number of unaddressed and more severe symptoms related to cancer and cancer-directed therapy. This article outlines plans to address the unique needs of TGD people through a TGD-focused oncology clinic. Such a clinic could be structured by upholding the following tenets: (1) champion a supportive, gender-affirming environment that seeks to continuously improve, (2) include a transdisciplinary team of specialists who are dedicated to TGD cancer care, and (3) initiate and embrace TGD-patient-centric research on health outcomes and health care delivery.

Patients' Attitudes Towards Medical Student Presence in Psychiatric Consultations

OBJECTIVES

Studies on patient-student relationships have to date largely focused on student attitudes. This study explores attitudes of patients with psychiatric illness in Ireland, towards medical students. Patients' experience of consent for student involvement is an area of concern in previous studies and is also quantified here.

METHODS

This was a mixed-methods cross-sectional survey of Irish adult psychiatric patients. Quantitative analysis was carried out using SPSS 22 (Statistical Product and Service Solutions, Version 22, IBM). Differences on Likert score between groups (male/female, hospital site, past experience with students/ no experience) were analysed using ordinal logistic regression with a p-value below 0.05 being significant. Qualitative data were analysed by thematic analysis using OpenCode 4.03.

RESULTS

A total of 340 patients completed the survey. The mean age (sd) was 44.8 (16.3). 52.8% were female, 75.2% were outpatients. 24.3% had never met a medical student. Most patients were comfortable seeing students, but preferred students being passive observers. Patients with previous student experience had higher comfort levels and more positive attitudes. Although most patients (63.7%) strongly agreed they had been asked for consent, only 49.3% felt they had been given sufficient information. Qualitative data revealed preference for adequate information and notice of involvement. Patients felt pressured by student presence in certain circumstances.

CONCLUSIONS

Psychiatric patients are comfortable with students but many feel inadequately informed. Patients recognise the benefits of interacting with students. More information is needed regarding circumstances in which patients give consent to involvement with students.

Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula

Background

Conventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives.

Methods

Study design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants' characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos.

Results

72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be "Helpful" in preparing physicians to provide competent medical care; however, 71.43% responded "No" to "Interest" in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as "Helpful" (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians.

Conclusion

While most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.

"Meet the patient" session: a strategy to teach medical students about autonomic dysfunction after spinal cord injury

Dysregulation of the autonomic nervous system is an important long-term consequence of spinal cord injury (SCI). Yet, there is a scarcity of teaching resources about this topic for preclinical medical students. Given the association of SCI sequelae with emergency complications and mortality, it is imperative to equip medical students with the ability to recognize them. We designed a "Meet the Patient" (MTP) session with the primary goal to enhance student learning about SCI sequelae by interacting with patients and listening to real-life stories. The session primarily focused on recognizing triggers and symptoms of autonomic dysreflexia (AD) and discussing the loss of bowel and bladder control, while providing opportunities to learn more about living with SCI from patients' real-life experiences. During the MTP session, patients living with SCI discussed their experience with AD, neurogenic bowel and bladder, and spasticity, among other SCI sequelae. We evaluated the outcomes of the MTP session by assessing numerical performance in questions related to the session (post-session quiz and final exam) and students' satisfaction (post-session survey) in two subsequent academic years. The numerical performance in SCI-questions was high for both academic years (and higher than national average for the final exam question), indicating adequate acquisition of knowledge. Satisfaction with the session was high, with most students indicating that the session helped them consolidate their knowledge about the topic.

Reflective based learning for nursing ethical competency during clinical practices

BACKGROUND

A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students.

AIM

To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies.

RESEARCH DESIGN

Qualitative study with a content analysis according to Elo and Kinglas framework.

PARTICIPANTS AND RESEARCH CONTEXT

Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women.

METHODOLOGY

The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method.

ETHICAL CONSIDERATIONS

Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form.

FINDINGS

Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity.

CONCLUSION

All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

BACKGROUND

Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context.

METHODS

Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level).

RESULTS

Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers.

DISCUSSION

Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely.

A "patient as educator" intervention: Reducing stigmatizing attitudes toward mental illness among medical students

Introduction

This pre-post quasi-experimental pilot study aimed to assess the degree of stigma toward mental illness and whether a single, direct-contact "patient as educator" intervention with people with mental illness can reduce the degree of stigma among medical students.

Methods

All second-year medical students from the University of Valencia were invited to voluntarily complete the Community Attitudes Toward the Mentally Ill (CAMI), Reported and Intended Behavior Scale (RIBS), and Mental Health Knowledge Scale (MAKS) questionnaires before and after participating in the formal medical psychology course. A "patient as educator" workshop with expert patients was organized in the middle of the semester. A total of 127 students completed the survey; 20 students participated in the workshop (workshop group), and the remaining 107 students only took the formal educational course, forming the control group.

Results

At baseline, the groups were demographically matched and did not differ in the components of stigma or knowledge of mental illness. After the intervention, a greater reduction in the CAMI subscales of authoritarianism and social restriction was observed in the workshop group than in the control group. In the workshop group, scores for the benevolence subscale of the CAMI decreased more among women than men. In the control group, scores for the authoritarianism and benevolence subscales of the CAMI increased and decreased significantly more, respectively, in women than men. No significant changes were observed in scores for the RIBS at post-intervention in either group.

Discussion

The results of this pilot study suggest that a brief, direct-contact intervention in addition to formal medical education may further help reduce stigmatizing attitudes during the first years of medical school.

"Why We Keep Coming Back": Family and Provider Perspectives on Factors Influencing Long-term Follow-up for Pediatric Cancer Survivorship Care

PURPOSE

The majority of childhood cancer survivors do not follow-up for long-term risk-based screening for recurrent illness and treatment late effects, despite a high prevalence of secondary morbidities. The primary aim of this study was to investigate factors that influence long-term follow-up for survivorship care, from the perspectives of providers, patients, and caregivers.

MATERIALS AND METHODS

A semistructured interview was designed to elicit stakeholder perspectives on factors that facilitate or impede routine clinic visits after completion of cancer therapy. Results were analyzed using a qualitative framework method.

RESULTS

Providers, patients, and caregivers identified a wide range of factors that might influence long-term follow-up for care. All respondents noted the importance of efficient clinical operations, resources such as parking, provider behaviors, rapport/attachment, and patient/family logistics. Compared with patients/caregivers, providers more frequently mentioned institutional operations, their own education and skills, patient/family understanding and motivation, and interpersonal processes such as communication style. Families more frequently mentioned clinic environment, and patients more frequently noted the importance of having a family member present, something neither providers nor caregivers reported.

CONCLUSIONS

Providers, patients, and patient caregivers have different perspectives regarding factors that may influence follow-up for long-term survivorship care. Understanding these differences can help inform efforts to improve follow-up.

Perspectives on inadequate preparation and training priorities for physicians working with sexual minority youth

OBJECTIVES

To understand pediatric and family medicine residents' and practitioners' perceived ability to work with lesbian, gay, bisexual, and queer (LGBQ) youth, assessment of their prior educational experiences, and recommendations for medical training to better prepare physicians to provide quality care to this population.

METHODS

We conducted semi-structured individual interviews with 24 pediatric/family medicine residents (n=20) and practicing physicians (n=4) in the U.S. Recorded interviews were professionally transcribed. Data were analyzed using Grounded Theory and qualitative content analysis approaches.

RESULTS

Most physicians did not feel adequately prepared to provide quality care to LGBQ youth, and many who felt knowledgeable obtained their knowledge from on-the-job experiences of caring for LGBQ patients. Findings regarding physicians' recommendations for implementing a formal training program revealed three themes: (I) medical school training (implemented earlier in medical school within a structured program as part of the normal curriculum), (II) training content (LGBQ-specific health needs, self-awareness of implicit biases, interviewing techniques, and resources), and (III) training strategies (panels of LGBQ patients, role-playing/standardized patients, and online modules).

CONCLUSIONS

Understanding physicians' assessment of abilities and recommendations for training improvements based on their experiences is important for advancing the quality of healthcare for LGBQ youth. Guidance came mostly from residents who recently completed medical school. Thus, their perspectives are especially useful to improve medical education and, ultimately, the care provided to LGBQ youth. Findings suggest a multi-pronged approach that offers several training modalities encompassing individual, intrapersonal, and institutional/systemic/community levels can improve medical school curricula on caring for LGBQ youth.

Do medical students and residents impact the quality of patient care? An assessment from different stakeholders in an Italian academic hospital, 2019

Medical students and residents play an important role in patient care and ward activities, thus they should follow hospital procedures and ensure best practices and patient safety. A survey concerning staff on training was conducted to assess the perceived quality of healthcare from healthcare workers (HCWs), residents, medical students and patients in Udine Academic Hospital, Italy. Between December, 2018 and March, 2019, a 5-point Likert-scale questionnaire was administered in 21 units, covering four thematic areas: patients and medical staff satisfaction with the quality of care provided by residents and students, patient privacy, clinical risk management, patient perception of staff on training. Data analysis included descriptive analysis and ordered logistic regressions. A total of 596/1,863 questionnaires were collected from: HCWs (165/772), residents (110/355), students (121/389), and patients (200/347). Residents were rated high both by patients (median = 5, IQR = 4–5, OR 0.49, 95%CI 0.26–0.93) and HCWs (median = 4, IQR = 3–5, OR 0.14, 95%CI 0.08–0.26), with a lower score for medical students on the same topic, both by patients (median = 4, IQR = 3–5, OR 2.94, 95%CI 1.49–5.78) and HCWs (median = 3, IQR = 2–3, OR 0.41, 95%CI 0.25–0.67). Therefore, the role of staff on training in quality and safety of healthcare deserves integrated regular evaluation, since direct interaction with patients contributes to patients’ perception of healthcare.

Learning Together: Engaging Patients as Partners in CPD

The goal of continuing professional development (CPD) is to improve patient care. However, traditionally, CPD has been planned and taught by clinicians, for clinicians, who tend to be protective of the professional-only environment for learning and are wary of the contributions and participation of patients. Although patients are sometimes included as guest speakers, this role has not typically extended to planning, content development, or serving as key faculty-ultimately excluding the patient perspective from the development and delivery of CPD. The absence of the patient perspective in CPD creates an inadvertent blind spot, hindering the opportunity for clinicians to hone patient-centric skills that are learned and practiced through training. As shared decision-making rises in importance among expected clinician competencies, the involvement of patients is becoming more essential. Patients can be our best teachers, and their inclusion in CPD can engage clinicians' hearts as well as minds and reinforce the reasons why our work matters. Patients are often more willing to engage in clinician education than we may realize, but educators must take the first step and invite them to participate and collaborate. This article will describe how to create a plan for engaging patients as partners, including guidance for gaining buy-in from leadership and faculty; recruiting, training, and nurturing patients; determining roles and responsibilities; and creating a safe space for patient participation.

Real-time patients' perspectives about participating in teaching consultations in primary care: A questionnaire study

INTRODUCTION

Patients presenting with undifferentiated illnesses provide valuable learning opportunities for medical students. Evidence detailing the factors that affect patient participation in undergraduate medical education is limited. This study examines how patients regard their participation in teaching consultations in primary care.

METHODS

We conducted a cross-sectional questionnaire survey in four GP practices. We tested the relationship between variables of interest and willingness to participate, using hierarchical logistic regression.

RESULTS

We analysed 525 questionnaires. 88% of respondents were willing to have students take part in their consultation, and 72% were willing to see a student alone before seeing the doctor. Older patients and those with less sensitive clinical problems were more likely to participate. Willingness to participate was also associated with patients' perceptions of certain costs and benefits of participation. Respondents had poor knowledge about medical education, and a sizeable minority perceived a lack of autonomy about the presence of students in their encounters. More than one-third of respondents expressed the presence of a clinician as a precondition for approval of students' performing some active roles.

DISCUSSION

The findings have identified potential interventions to enhance patient involvement including patient education, respecting patient autonomy, and ensuring appropriate student supervision.

Key tips for teaching in the clinical setting

Teaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines - particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.

Role of active patient involvement in undergraduate medical education: a systematic review

OBJECTIVES

To identify the scope of active patient involvement in medical education, addressing the current knowledge gaps relating to rationale and motivation for involvement, recruitment and preparation, roles, learning outcomes and key procedural contributors.

METHODS

The authors performed a systematic search of the PubMed database of publications between 2003 and 2018. Original studies in which patients take on active roles in the development, delivery or evaluation of undergraduate medical education and written in English were eligible for inclusion. Included studies' references were searched for additional articles. Quality of papers was assessed using the Mixed Methods Appraisal Tool.

RESULTS

49 articles were included in the review. Drivers for patient involvement included policy requirements and patients' own motivations to contribute to society and learning. Patients were engaged in a variety of educational settings in and outside of the hospital. The vast majority of studies describe patients taking on the role of a patient teacher and formative assessor. More recent studies suggest that patients are increasingly involved in course and curriculum development, student selection and summative assessment. The new body of empirical evidence shows the wide range of learning objectives was pursued through patient participation, including competencies as professional, communicator, collaborator, leader and health advocate, but not scholar. Measures to support sustainable patient involvement included longitudinal institutional incorporation, patient recruitment and/or training, resource support and clear commitment by faculty. The importance and advantages of patient involvement were highlighted by students, faculty and patients themselves; however, organisations must continue to consider, monitor and take steps to mitigate any potential harms to patients and students.

DISCUSSION

This systematic review provides new knowledge and practical insights to physicians and faculty on how to incorporate active patient involvement in their institutions and daily practice, and provides suggested action points to patient organisations wishing to engage in medical education.

Pelvic floor examination performed by medical students: a model to obtain consent

Student-led clinical examinations, including pelvic floor examinations, are an integral part of clinical training and can be beneficial to both students and patients alike. However, our experience and previous literature catalog numerous obstacles in obtaining consent for student-led pelvic floor examinations. Although some of these factors may not be modifiable, it is evident that efforts can be made to overcome those that are. An examination of these obstacles can help to provide a clear and succinct template to overcoming them: we propose a "5-Rs" framework that may bridge the apparent gap between the students' need to practice and obtain valid consent.

Engaging Transgender Patients: Using Social Media to Inform Medical Practice and Research in Transgender Health

Despite accelerated growth in the field of transgender health, mistrust between trans patients and their providers persists. Insufficient education for providers, research that overlooks patients' foremost concerns, and continued stigma and discrimination in medical settings are among the main barriers leading trans patients to delay or avoid care. Consequently, the transgender community often turns to social media as a self-serve resource for medical knowledge. This article discusses the benefits of directly engaging the trans community using social media to educate professionals, drive relevant research, and inform practice, to ultimately deliver higher quality care.

Islamic jurisprudential and ethical considerations of practicing medical procedures on nearly dead patients: Part I (The theoretical section)

End-of-life care and protection of the patient in the near-death moments are part of a patient's rights and the duties of the medical staff. As the beginning and end of human life are most sensitive moments, there are various religious rules associated with them. The ethical issues regarding practicing medical procedures on nearly dead patients are of particular complexity and are consistent with invaluable and profoundly religious recommendations. In addition, the purpose of medical training is to provide physicians with the knowledge and skills necessary to practice appropriately and within legal and ethical frameworks. Therefore, respecting patients' cultural and religious beliefs is an ethically accepted principle in the health systems of different countries and is the basis of respect for human dignity. The present study used a qualitative content analysis to explain how to practice medical procedures on a dying or nearly dead patient in accordance with Islamic jurisprudential rules. It was finally concluded that according to the Islamic jurisprudential rules of "authority", "no harm", "necessity", and "public interest", procedures performed on a dying patient could be used for training purposes under certain circumstances. Nevertheless, such activities should only be done with the patient's permission and provided they cause no unnecessary harassment, and they may take place in the absence of alternative methods.

Patient Perception of Medical Learners and Medical Education during Clinical Consultation at a Family Medicine Residency

INTRODUCTION

Experience in treating patients under supervision of faculty is an important factor in medical education at all levels. However, unpleasant patient experiences with a medical learner during clinical consultation can damage the relationship between the medical learner, physician supervisor, and patient. A goal of this study was to examine patient experiences and preferences regarding medical learners during clinical consultation at a family medicine residency clinic. Another goal was to determine factors relating to patients' experiences and preferences regarding medical learners.

METHODS

This cross-sectional study relied on patients completing a survey designed from extant questionnaires to measure patients' experiences and preferences relating to interactions with medical learners at a family medicine clinic. Data were collected from 216 patients between December 2016 and August 2017. We correlated patients' feelings, overall experiences with medical learners and the importance of medical education.

RESULTS

There was a 93% participation rate. The patients rated their overall experiences with medical learners as 3.8 on a 5-point scale, suggesting positive experiences. Eighty-eight percent prefer not more than three medical learners to be involved in their care during clinical consultation. Patients' overall experiences with medical learners participating in medical care correlated with their preferences regarding medical learners' involvement in their treatment (r[209] = .524; p = 0.01). Patients' perception of medical learners participating in medical care correlated with the importance of medical education (r[209] = .878; p = 0.01).

CONCLUSIONS

The results showed that most patients have positive experiences with medical learners and are generally in favor of medical education.

Teaching & Learning Tips 11: Teaching a procedure

Challenge: Balancing patient-centered clinical care with learner-centered teaching in a clinical setting becomes particularly challenging when it comes to teaching procedures to trainees (e.g. biopsies, excisions, etc.). How can procedures be taught in a way that reinforces repetition and mastery without compromising patient safety, care, and comfort?

Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives

BACKGROUND

Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education.

AIM

This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information.

DESIGN AND SETTING

Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching.

METHOD

Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically.

RESULTS

Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs' involvement in teaching, and initiating student-patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback.

CONCLUSION

This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters.

Monitoring and analysis of vital signs of a patient through a multi-agent application system

In the medical environment, the clinical study of the most basic vital signs of a patient represents the simplest and most effective way to detect and monitor health problems. There are many diseases that can be diagnosed and controlled through regular monitoring of these medical data. The purpose of this study is to develop a monitoring and tracking system for the various vital signs of a patient. In particular, this work focuses on the design of a multi-agent architecture composed of virtual organizations with capabilities to integrate different medical sensors on an open, low-cost hardware platform. This system integrates hardware and software elements needed for the routine measurement of vital signs, performed by the patient or caregiver without having to go to a medical center.

Patients' Perceptions Towards the Participation of Medical Students in their Care

OBJECTIVES

Patient interaction is a vital part of healthcare training. This study aimed to investigate patients' perceptions of the participation of medical students in their care.

METHODS

This descriptive cross-sectional study was conducted between October 2014 and March 2015 among 430 patients admitted to the medical and surgical wards at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. An Arabic questionnaire was designed to assess the demographic characteristics of the patients and their perceptions of students' participation in their medical care.

RESULTS

A total of 416 patients completed the survey (response rate: 97%). Overall, 407 patients (98%) acknowledged the educational benefit of involving medical students in their care. A total of 368 patients (88%) had no objection to a medical student being involved in their care. Of these, 98% were willing to be asked about their medical history by medical students, 89% would permit physical examinations by medical students and 39% preferred that the gender of the medical student match their own. Education level (P <0.003), a positive prior experience with a medical student (P <0.001) and perception of the medical students' attitudes (P <0.001) had a significant effect on patients' acceptance of medical students participating in their care.

CONCLUSION

In general, the patients had a positive perception of medical students, with most patients acknowledging the educational benefit of student participation in patient care. As patients' perceptions of students' professionalism, confidence and respect for privacy were significantly related to acceptance of care, education on these aspects should be a priority in medical curricula.

Patients' attitude towards bedside teaching in Tunisia

OBJECTIVE

To assess patient' reaction towards bedside teaching at the University Hospital of Monastir (Tunisia) and to identify the factors that may influence it.

METHODS

A cross-sectional study was conducted during December 2012 at the University Hospital of Monastir. Each department, except the psychiatric department and the intensive care units, was visited in one day. All inpatients present on the day of the study were interviewed by four trained female nurses using a structured questionnaire.

RESULTS

Of the 401 patients approached, 356 (88.8%) agreed to participate. In general, the results demonstrate that patients were positive toward medical students' participation. The highest acceptance rates were found in situations where there is no direct contact between the patient and the student (e.g. when reading their medical file, attending ward rounds and observing doctor examining them). As the degree of students' involvement increased, the refusal rate increased. Gender, age, educational level, marital status and the extent of students' involvement in patient's care were identified as the main factors affecting patients' attitude.

CONCLUSIONS

Taking advantage of this attitude, valorizing patient role as educator and using further learning methods in situations where patient's consent for student involvement was not obtained should be considered to guarantee optimal care and safety to patients and good medical education to future physicians.

Supervised pharmacy student-led medication review in primary care for patients with type 2 diabetes: a randomised controlled pilot study

OBJECTIVE

To pilot and feasibility-test supervised final year undergraduate pharmacy student-led medication reviews for patients with diabetes to enable definitive trial design.

METHOD

Third year pharmacy students were recruited from one UK School of Pharmacy and trained to review patient's medical records and provide face-to-face consultations under supervision while situated within the patient's medical practice. Patients with type 2 diabetes were recruited by postal invitation letter from their medical practice and randomised via automated system to intervention or usual care. Diabetes-related clinical data, quality of life, patient reported beliefs, adherence and satisfaction with medicines information were collected with validated tools at baseline and 6 months postintervention. The process for collecting resource utilisation data was tested. Stakeholder meetings were held before and after intervention to develop study design and learn from its implementation. Recruitment and attrition rates were determined plus the quality of the outcome data. Power calculations for a definitive trial were performed on the different outcome measures to identify the most appropriate primary outcome measure.

RESULTS

792 patients were identified as eligible from five medical practices. 133 (16.8%) were recruited and randomised to control (n=66) or usual care (n=67). 32 students provided the complete intervention to 58 patients. Initial data analysis showed potential for impact in the right direction for some outcomes measured including glycated haemoglobin, quality of life and patient satisfaction with information about medicines. The intervention was found to be feasible and acceptable to patients. The pilot and feasibility study enabled the design of a future full randomised controlled trial.

CONCLUSIONS

Student and patient recruitment are possible. The intervention was well received and demonstrated some potential benefits. While the intervention was relatively inexpensive and provided an experiential learning opportunity for pharmacy students, its cost-effectiveness remains to be determined.

TRIAL REGISTRATION NUMBER

ISRCTN26445805; Results.

What Should General Practice Trainees Learn about Atopic Eczema?

Effective atopic eczema (AE) control not only improves quality of life but may also prevent the atopic march. The Royal College of General Practitioners’ (RCGP) curriculum does not currently provide specific learning outcomes on AE management. We aimed to gain consensus on learning outcomes to inform curriculum development. A modified Delphi method was used with questionnaires distributed to gather the views of a range of health care professionals (HCPs) including general practitioners (GPs), dermatologists, dermatology nurses and parents of children with AE attending a dedicated paediatric dermatology clinic. Ninety-one questionnaires were distributed to 61 HCPs and 30 parents; 81 were returned. All agreed that learning should focus on the common clinical features, complications and management of AE and the need to appreciate its psychosocial impact. Areas of divergence included knowledge of alternative therapies. Parents felt GPs should better understand how to identify, manage and refer severe AD and recognized the value of the specialist eczema nurse. Dermatologists and parents highlighted inconsistencies in advice regarding topical steroids. This study identifies important areas for inclusion as learning outcomes on AE management in the RCGP curriculum and highlights the importance of patients and parents as a valuable resource in the development of medical education.

Medical Students' and Physicians' Attitudes toward Patients' Consent to Participate in Clinical Training

INTRODUCTION

The responsibility of the medical training team towards a patient referring to an academic medical center has not been fully clarified. In this article we have looked at current practice in Medical University of Isfahan and evaluated the attitude of the medical team towards patients'consent to be involved in medical students'education.

METHODS

In this cross-sectional study, conducted in 2012, we distributed self-administrated questionnaires among medical mentors, residents and students of academic hospitals in Isfahan, Iran. This researcher-made questionnaire consisted of several questions concerning dimensions of informed consent. The data were analyzed, using independent t-tests and ANOVA.

RESULTS

Ninety-one medical students (51 females) and 61 members of medical training team (25 females) completed the questionnaires. The overall average attitude score was 36.53±5.89 out of 60, which is classified as fair. The average attitude score for medical students and mentors were not significantly different. The average attitude score of the female students was classified as good, and was different from that of male students, significantly (p<0.05). By categorizing subjects into those with≥5 years of managerial or educational experience and those below 5, a significant difference in average attitude score was documented (35.8±2.54 in≥5and 34.0±2.9 in>5group).

CONCLUSION

The attitude of the medical team is thoroughly far from what is expected. Thus, the need to provide both medical students and medical mentors with data on the importance of obtaining patients' consent to be involved in medical education is highlighted.

Patient experiences of participation in a medical student teaching workshop

OBJECTIVES

To investigate the motivations for and experiences of patients who actively participate in a workshop to teach medical students about chronic disease.

DESIGN

Descriptive study using structured telephone or e-mail-based questionnaire exploring the views of 'patient tutors' who participate in a 'living with chronic disease' workshop.

PARTICIPANTS

'Patient tutors' with a chronic medical condition who had participated in at least one 'living with chronic disease' workshop for medical students at Oxford University Medical School.

RESULTS

Patient motivating factors can be divided into two groups, direct benefits such as companionship or improved knowledge of their condition, and a teaching role involving an altruistic desire to give something back, and wanting to educate the doctors of the future. Importantly, most patients participated multiple times over a number of years despite no remuneration for their time other than expenses.

CONCLUSIONS

Patients appear highly motivated to educate medical students about chronic disease, due to a combination of personal benefits and an altruistic desire to 'give something back'. This suggests that they present an invaluable and currently undermobilized resource for the future of medical education.

Physician shadowing by college students: what do patients think?

BACKGROUND

The objective of this study is to determine patients' perceptions of physician shadowing by college students.

METHODS

Thirty-two patients who agreed to have a college student shadow their physician participated in semi-structured interviews during July and August 2013 at two outpatient family medicine centers. Qualitative techniques were utilized to analyze the transcripts of the patient interviews and identify common themes.

RESULTS

The majority of patients (78.1%) felt the college student had a neutral effect on their visit and denied having concerns about confidentiality (87.5%). No patient felt that having the college student present affected their ability to maintain a trusting relationship with their physician. Three themes emerged from the qualitative analysis: benefits to students, willing participation and sensitive issues. Most patients (78.5%) recognized that the student was in college or was a premedical student. The overwhelming majority of patients stated that they would have a college student shadow their physician again in the future.

CONCLUSIONS

Despite concerns raised by other authors about the possible negative effects of physician shadowing by college students, this study shows that patients feel the impact to be primarily neutral and that there are many perceived benefits to both student and patient.

Enhancing clinical skill development through an Ambulatory Medicine Teaching Programme: an evaluation study

BACKGROUND

Teaching of clinical skills traditionally takes place in hospital wards and outpatient settings. However high acuity and short hospital stays means there are fewer suitable inpatients available for teaching; and time pressures limit students' involvement in other settings. The Ambulatory Medicine Programme was established to develop undergraduate medical students' clinical skills by providing increased exposure to patients with a wide range of chronic medical conditions, in a dedicated learning environment.

METHOD

A mixed qualitative/quantitative approach was used to evaluate the Programme. This research focuses on staff and student perspectives of teaching and learning in Ambulatory Medicine compared with inpatient and outpatient settings; identifies which teaching methods are considered most effective; and determines the transferability of learning. Patients' perspectives of being involved in student teaching are also reported.

RESULTS

Results show that the programme has made a positive impact on students' development of clinical skills, which are transferable to the clinical setting. Patients enjoy being involved and find it personally satisfying.

CONCLUSIONS

The Ambulatory Medicine Programme is an effective way of developing medical students' clinical skills by providing focussed teaching with real patients in a dedicated learning environment.

The role of radiotherapy patients in provision of student interpersonal skills feedback

Background

At Queensland University of Technology, student radiation therapists receive regular feedback from clinical staff relating to clinical interpersonal skills. Although this is of great value, there is anecdotal evidence that students communicate differently with patients when under observation.

Purpose

The aim of this pilot was to counter this perceived observer effect by allowing patients to provide students with additional feedback.

Materials and methods

Radiotherapy patients from two departments were provided with anonymous feedback forms relating to aspects of student interpersonal skills. Clinical assessors, mentors and students were also provided with feedback forms, including questions about the role of patient feedback. Patient perceptions of student performance were correlated with staff feedback and assessment scores.

Results

Results indicated that the feedback was valued by both students and patients. Students reported that the additional dimension focused them on communication, set goals for development and increased motivation. These changes derived from both feedback and study participation, suggesting that the questionnaires could be a useful teaching tool. Patients scored more generously than mentors, although there was agreement in relative grading.

Conclusions

The anonymous questionnaire is a convenient and valuable method of gathering patient feedback on students. Future iterations will determine the optimum timing for this method of feedback.

Patients' attitude towards medical students involvement in their health care at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2010

BACKGROUND

Patients' willingness to the involvement of medical students in their health care is the mandatory input to medical education. Admitted patients' willingness level should be known and factors affecting willingness should be identified and it is necessary to act upon them for better medical care.

METHODOLOGY

A cross-sectional hospital based survey was conducted to assess the admitted patients' attitude towards medical students' involvement in their health care at Tikur Anbesa Specialized Hospital in 2010. Data were collected from 422 adult patients admitted in Tikur Anbesa Specialized Hospital from April to May 2010 using structured questionnaire and by interview method. The data gathered in this way were then processed using SPSS version 15.

RESULT

Three hundred and ninety-two participants had responded to all questions they were asked (response rate = 92.8%). One hundred and five (26.8%) patients had negative attitude to medical students' involvement in their health care. The proportion of patients' having positive attitude towards students was slightly reduced from medical to surgical and to gynecology wards 77.4%, 72.0%, 69.2% respectively. Patients who had previous interactions with students were more likely to have negative attitude (AOR (95% CI) = 1.72(1.03, 2.87). The odds patients admitted in gynecology and obstetrics ward to prefer female students to care for them was higher (AOR (95% CI) =1.93(1.13, 3.30).

CONCLUSION

Almost half of the patients admitted to Tikur Anbessa Specialized Hospital objected to clinical procedures on them even physical examination, hence developing clinical skills in TASH might be challenging for the majority of students. The challenge might be worsened for male students in gynecology wards.

Impact of increased authenticity in instructional format on preclerkship students' performance: a two-year, prospective, randomized study

PURPOSE

To address whether increasingly authentic instructional formats are more effective in improving preclerkship medical students' performance.

METHOD

From 2007 to 2009, the authors conducted a prospective, randomized, crossover study with second-year medical students in a clinical reasoning course at the Uniformed Services University of the Health Sciences. The authors randomly assigned students to one of three cohorts and used instructional formats of differing authenticity (paper, DVD, standardized patient) to teach three subject areas (abdominal pain, anemia, polyuria). Each cohort received one instructional format for each subject area. The authors collected outcome measures (objective structured clinical exam, video quiz, and essay exam scores) at the end of each academic year. They stratified the students into tertiles by first-year grade point average to investigate the impact of instructional formats on learners of different abilities.

RESULTS

Outcomes for students in the top tertile improved with increased authenticity of the instructional format compared with outcomes for students in the middle and bottom tertiles (0.188 versus -0.038 and -0.201, P=.001 and .027, respectively). However, outcomes for students in the bottom tertile decreased when students were given only the paper case, compared with the middle and top tertiles (-0.374 versus 0.043 and 0.023, respectively, P=.001), but subsequently improved with more authentic instructional formats.

CONCLUSIONS

The authors could not demonstrate that increased authenticity of the instructional format resulted in improved learner performance. However, they believe that there may be some benefit to tailoring preclerkship clinical education based on students' ability.

Patients' attitudes towards medical students in a teaching family practice: a sri lankan experience

Background:

Faculty of Medicine, University of Kelaniya, Sri Lanka conducts a one month under graduate training programme during their fourth year at the University family practice centre. Students get training in history taking, clinical examination, patient management and practice management during this attachment. This study was conducted to look at the patients’ attitude towards student participation during consultation.

Materials and Methods:

This was a descriptive cross sectional study. All the patients who were 16 years and above during a 2 month period were included in the study. Structured questionnaire was administered by demonstrators following a consultation where students were present. Their demographic data, number of consultations with student participation and questions related to presence of students at various stages of the consultation were asked.

Results:

Total of 85 patients took part in the study and 81.3% of them were females. 88.8% were of the opinion that they benefited by the interaction with medical students while 93.8% thought students understood their problems. 26.3% patients preferred a medical student of the same sex during consultation while 71.3 had not expressed any opinion in this regard. Only 3.8% and 5% wanted the doctor alone during history taking and examination respectively. Almost every patient was happy that they could help the undergraduate training.

Discussion:

As expected results of the study showed that patients were willing to take part in undergraduate training without any reservation. These results are compatible with the previous studies done in the western world and data is not available form either Sri Lanka or other Asian countries.

Patient selection for bedside teaching: inclusion and exclusion criteria used by teachers

CONTEXT

Bedside teaching encounters on hospital wards offer medical students opportunities to learn key medical and interpersonal skills. Although many aspects of bedside teaching have been studied, not much is known about the selection process used by medical teachers to find patients for these encounters. Patient selection could have a substantial impact on medical students' clinical experiences. Therefore, we studied the ways in which medical teachers select patients for bedside teaching and tried to determine the factors that affect patient selection.

METHODS

Using a qualitative research approach, we interviewed 15 teachers from three departments within the Medical Faculty at Hamburg University on how they choose patients for bedside teaching encounters. We extracted selection criteria from the transcripts of the audio-recorded interviews and identified other factors that influenced selection.

RESULTS

One main category and two minor categories of factors relevant to patient selection were identified: educational; bio-psycho-social, and structural. Medical teachers look primarily for patients who have diseases that fit their conceptions of the learning objectives of the lessons in question. The two minor categories influence their choice of patients in different ways. By finding a balance between these categories, they decide which patients are eligible for participation. As a result of these selection criteria, some patients are more likely to become involved in clinical teaching, whereas others may be omitted.

CONCLUSIONS

Patient selection for bedside teaching is based on several criteria. Non-representative patient selection may narrow the learning experiences of medical students. Curriculum planners need to be aware that specific aspects of medical care may be neglected as a result of the exclusion of some patients. Teacher training and additional teaching formats should be provided to ensure that these are covered.

Peer-assisted learning in teaching clinical examination to junior medical students

BACKGROUND

In medical education, peer-assisted learning (PAL) refers to teaching occurring between fellow students. Few descriptions of its use to teach clinical examination have been published. Student Grand Rounds (SGR) is a student-led initiative whereby senior students volunteer to teach clinical examination to pre-clinical peers. Student tutors attend a modified Teaching on the Run (TOTR) course originally designed to train clinicians to teach students and junior doctors.

AIM

We investigated the value of SGR in teaching pre-clinical students, and evaluated the effectiveness of TOTR.

METHODS

Over 9 months, tutors and participants in each SGR tutorial completed an online survey. At the conclusion of annual TOTR workshops (2004-2010), participants evaluated their impressions of the course.

RESULTS

A total of 64 SGR tutorials were attended by a total of 321 students. All agreed that tutorials were beneficial and enjoyable, with a threefold increase in the number of students self-identifying as able to perform the skills required. TOTR participants classified the course as both relevant and beneficial, and all course outcomes were achieved. SGR tutors reported improved knowledge and confidence in teaching following SGR and TOTR.

CONCLUSION

PAL is effective in supplementing teaching of clinical examination. Senior students learn valuable skills and gain experience in teaching.

Patient perceptions of medical students' involvement in their obstetrics and gynaecology health care

OBJECTIVE

  To determine perceptions held by patients of the involvement of medical students in their obstetrics and gynaecology health care.

STUDY DESIGN

  This study evaluated patients' perceptions of medical students involved in their care at a tertiary women's hospital. A questionnaire was used to collect patients' perceptions of the student's professional skills, their attitude to and level of comfort in the patient and student interaction.

RESULTS

  Ninety-five percent of patients approached participated in this study. Results demonstrated a high level of patient satisfaction with student involvement in care. Most patients believed students should be part of the hospital team and were prepared to have a student involved in the future. Satisfaction levels were higher for patients for whom English was their first language, women under 40 years of age and those receiving care in assessment and in-patient settings. Patient comfort in student participation was greater for those seen by a female student and those who had previously had a student involved in their care or previously attended the hospital.

CONCLUSION

  Patient perceptions of students' involvement in their obstetrics and gynaecology care are mainly positive. Satisfaction levels differ with the gender of the student, the age of the patient, the location of care and for those for whom English is their first language. Attention must be paid to informing patients of the presence and possible level of interaction of students in their care.

Learning to listen: improving students' communication with disabled people

BACKGROUND

This report outlines the action research used to develop a workshop for interprofessional student groups to enhance listening skills.

AIM

The project aimed to enable students to reflect interprofessionally on the human factors central to effective communication using the power of storytelling by disabled people and their carers.

METHODS

Qualitative data from students and participating service users were collected using focus groups and one-to-one interviews over three pilot cycles.

RESULTS

The results from each pilot informed the cyclical development of the project so that each stage of data collection informed the next stage. During the pilots, 20 interviews with service users were completed and a total of 109 students participated. Transcribed data were analysed using principles from grounded theory. Quantitative scored questions on students' learning were analysed using statistical package for the social sciences.

CONCLUSIONS

Both students (health and social care) and users benefitted from the education process which delivered highly relevant explicit learning opportunities, with analysis of how to improve communication for safe practice. Students benefitted from meaningful interactions with service users who shared their experiences and gave feedback on students' communication skills. The final workshop design resulted in a learning model which reflects the human side of healthcare delivery.

Involving patients in clinical education

The interdependent relationship between the clinical teacher, the learner and the patient is a vital part of clinical education. Changing health services and patient expectations have stimulated the need for teachers to consider patients' rights and needs as active participants and partners in clinical teaching.

Perspective: authentic patient perspectives in simulations for procedural and surgical skills

In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

[Development and evaluation of an information leaflet for patients consulting an university hospital dental clinic]

BACKGROUND

Dental clinics in university hospitals have several roles; dental care is delivered to patients while dental students learn clinical practice. Patients are subjected thus to specific constraints in those mixed hospital-university structures. Patients should be informed of how these structures work and their consent must be carefully sought. Otherwise, patients could manifest their refusal to receive care by interrupting the treatment process.

METHODS

This study was aimed to develop an information leaflet about the organisation of the dental clinic of the university hospital of Clermont-Ferrand. A quasi-randomised controlled study was conducted to evaluate the impact of this leaflet on patients' knowledge and absenteeism. The types of information to be included in the leaflet were determined using focus groups with patients, students and practitioners. The design, appropriateness and clarity of the leaflet were pilot tested among 30 patients. The evaluation of the impact of the leaflet was conducted among new patients who visited the dental clinic in 2007-2008. Patients were randomly allocated to three groups; one group (G1) received the leaflet at home by mail before the first visit, one group (G2) benefited from the leaflet during the first visit and one group (G3) did not receive the leaflet. The number of patients present at their appointment was recorded during the first visit (G1, G2, G3) and the second one (G2, G3). The knowledge of the patients about the dental clinic was evaluated by using a self-administered questionnaire before (except G1) and after reading the leaflet.

RESULTS

The study population included 269 patients; 94 answered the two successive questionnaires (G1=32, G2=30, G3=31). At baseline, patients did not have sufficient knowledge about the way the dental clinic was functioning. The leaflet partly improved the level of knowledge of the patients when it was given during the first visit. About 25 % of the patients were not present at their appointment and this rate was not influenced by the distribution of the leaflet.

CONCLUSION

The distribution of a leaflet, explaining the organisation of a university dental clinic, slightly improves the knowledge of new patients about this kind of care structure.

The ethics of anaesthesia learning curves

While the concept of the 'learning curve' is widely accepted and understood in medical education, the ethical appreciation of what this involves for patients has been under-represented in medical journals. Advances in medical technology have produced an armoury of diagnostic and therapeutic invasive procedures, which must be perfected by anaesthetists for the benefit of patients. Anaesthetic training involves practice using patients, which potentially exposes patients to excess procedural risk. However, such risk can be minimised through close supervision of trainees and the development of non-patient training aids. Most importantly, for training to be ethical, it must involve the patient: it is for patients to decide whether they consent to taking part in training and their consent should always be sought where possible.