Online teaching of medical students by patients during covid-19 is set to become the new norm
How patients are involved as teachers at the University of Montreal
Mathieu Jackson, coordinator of the School of Partnership, Center of Excellence on Partnerships with Patients and the Public and Annie Descoteaux, manager of the Collaboration and Patient Partnership Unit.
Patient trainers and practising healthcare professionals have been co-leading workshops for students in the 13 different departments of health science at the University of Montreal for ten years. The patient trainers are recruited and trained to take on a teaching role by the Collaboration and Patient Partnership Unit (CPPU) in the Faculty of Medicine which is co-directed by Vincent Dumez and Philippe Karazivan, who is a general practitioner. The patients who undertake this training are mostly people living with long term conditions. The workshops form part of a three year shared curriculum between all the health sciences departments and encompass around 4500 students per year (Pomey et al, 2015).
During the workshops, patient trainers describe their “healthcare journey” and talk about the knowledge they have accumulated on navigating the healthcare system and managing their own illness. Discussion and various activities then follow, co-led by the patients and healthcare professionals, to bring together these perspectives with between 10 and 40 students from any of the 13 different healthcare programmes. The topics discussed include interdisciplinary collaboration, the role of the patient as an active member of the healthcare team, self management of illness, shared decision making and the organisation of healthcare.
All patients trainers involved in teaching activities at University of Montreal are considered experts by experience and receive financial compensation for their time. Patients trainers associated with the CPPU often participate in many workshops over several years and many take on other patient partnership and advocacy roles in the health system.
Rapid change in the face of covid-19
With the sudden onset of covid-19, many of the health professionals on the interfaculty committee were rapidly deployed to work at the frontline of care. Patient trainers with long term conditions were deemed at risk, and the University closed its doors and mandated that all courses be conducted online. This prompted the patient trainers and faculty teachers to move quickly to develop a new online approach to teaching students to replace the former face-to-face workshops.
The course was designed to get students to work in teams drawn from different faculties to draw-up clinical vignettes accompanied by 2 SMART (Specific, Measurable, Attainable, Realistic, Timely) objectives. These were then sent by e-mail to patient trainers for comments which were collated via a co-developed and previously tested evaluation grid, with space given for additional feedback. The feedback was primarily around the partnership elements of the case. Students then had to integrate the patients recommendations into their vignettes. In preparation for this, patients trainers received a one-hour online training followed by a one-hour follow-up meeting. 35 patients trainers participated in this activity.
Benoit-Pierre Stock, Patient trainer, Université de Montréal
As a patient-partner, I shared my experience with students in the Collaboration in Health Sciences courses at the University of Montreal. Thanks to our exchanges, the students better understood the reality that I was confronted with during my hospital journey. During my interactions with them, they were also made aware of the post-operative consequences I experienced on returning home. My patient journey also provides a concrete example about the importance of interdisciplinary collaboration in a healthcare team.
Because of the covid-19 crisis, the previous interactive contact I had with the students during the workshops was cut, but I was pleased to receive online training on how to submit written feedback on case studies provided by groups of interdisciplinary students.
I found it stimulating to comment on the students’ work in a way which enabled me to target my comments at the specific groups of students who wrote the case, e.g. medical staff, nurses, occupational therapists, physiotherapy students, etc. My feedback to each had to be constructive, clear, and precise. It aimed to provide students with avenues for reflection concerning actions to be taken and on the implementation of a collaborative professional practice in partnership with patients.
Reading the students co written vignettes enabled me to learn about the views and perspectives of health and medical students. I feel like it has also stimulated me to give more constructive and detailed feedback to the students. It has been a difficult exercise, but very exciting, enriching and instructive.
Marie-Claude Vanier, Full Clinical Professor, Faculty of pharmacy, Université de Montréal
Students tell us that patient participation in our interprofessional workshops is one of their favourite elements of their course. Covid-19 forced us to adapt very quickly and provide an online version of our face-to-face workshop for second year undergraduate students. We considered running online workshops facilitated by patients, but worried this might pose technological challenges for some of them and time was too short for the required training for this. So a group of patients and professors, including myself, co-constructed an online workshop in a few days.
I was impressed by the leadership shown by our colleagues from the Collaboration and Patient Partnership Unit. They selected their most experienced members, and trained and supported them to undertake a new role commenting on clinical case vignettes. We ensured that faculty staff with clinical experience were available to support patients taking on a new online feedback teaching role but in the event their help was not needed. I was pleased to observe how patients’ online feedback triggered positive self-reflection and enriched the learning experience of my students.
Samuel Sassine, second year medical student
My experience as a second year student has been positive despite the exceptional situation due to covid-19. Indeed, the “virtual shift” has helped develop my non-clinical but equally essential skills for interdisciplinary collaboration and patient partnership including good communication, and the ability to synthesise and organise information.
Knowing that we were not going to have patient partners with us in the room during the training worried me initially, for fear of missing out on direct feedback from them. However, the comments they sent electronically were very useful and gave us precise elements to improve. In my case, the patient partner raised the need for a good understanding of the life plan of the care users. He also gave us concrete examples of situations where this could be forgotten in different clinical contexts. The fact that we had to do some reflective work after receiving comments from the patient partner allowed us to understand the meaning of the feedback while allowing us to clearly understand concepts related to patient-partnership.
Online teaching of medical students by patients—set to become the new norm?
Céline Huot, Full Clinical Professor, Faculty of Medicine, Université de Montréal
In March 2020, the covid-19 pandemic brought face-to-face teaching and interactions to a standstill on the campus. Uncertainty regarding the pursuit of the curriculum generated much anxiety among medical students, a sentiment accentuated by the reassignment of many physician professors to the care of patients struck by the virus. At this time, second year students had completed the required online training and an intradisciplinary workshop in preparation for an interdisciplinary interprofessional workshop with patient partners. With a leap of faith, there was a joint agreement to modify the interprofessional workshop into an online training programme. Following the workshop, groups of students submitted their intervention plan for review by a patient partner with the assumption that such input would reinforce or encourage plans in accordance with patients goals and preferences.
I was delighted with the way health care and social services professionals and patient partners came together to jointly develop and implemented the new activity. Medical students deemed the feedback provided by patient partners to be relevant and impactful. Under unprecedented circumstances, a unique collaborative practice has emerged. “The success factors for this rapid and effective transformation were engagement, leadership and shared vision, both from patients and professors. This new way to involve patients, giving them increased responsibility and autonomy in giving student feedback might, like many other things, become for us a new normal after Covid-19.” – Marie-Claude Vanier
This article was co-authored by Annie Descoteaux and Mathieu Jackson, from the Centre of Excellence on Partnerships with Patients and the Public (CEPPP) and the Collaboration and Patient Partnership Unit (CPPU) at University of Montreal
Annie Descoteaux, manager of the Collaboration and Patient Partnership Unit (CPPU), Faculty of Medicine, University of Montreal.
Mathieu Jackson, coordinator of the School of Partnership, Center of Excellence on Partnerships with Patients and the Public (CEPPP), University of Montreal Hospital Research Center (CRCHUM).
Acknowledgements: Anne Charbonneau, Vice-Dean of the Faculty of Dentistry of University of Montreal
Competing interests: None declared
References:
Pomey, M. P., Flora, L., Karazivan, P., Dumez, V., Lebel, P., Vanier, M. C., … & Jouet, E. (2015). Le «Montreal model»: enjeux du partenariat relationnel entre patients et professionnels de la santé. Santé publique, 1(HS), 41-50.
Links:
Collaboration and patient partnership unit (CPPU): https://medecine.umontreal.ca/faculte/direction-collaboration-partenariat-patient/
Center of excellence on partnerships with patients and the public: https://ceppp.ca/en/