A friend recently posted a link to a video showing a stereotypical conversation of an orthopaedic surgeon asking an anaesthetist for help because he wanted to repair a fracture. It went something like this…

Orthopaedic surgeon (OS): I need to book a case
Anaesthetist (A): what’s the story?
OS: There is a fracture, I need to fix it
A: tell me more
OS: [prolonged and mystified silence] There is a fracture, I need to fix it
A: can you tell me more?
OS: the fracture is very displaced, I need to fix it
A: Ok, let’s start from the basics, where is the fracture
OS: the fracture is in the emergency department

Every profession has its struggles with this type of thing.  Phrases like ‘the appendix in bed 3’ are an often used short-hand that omits as much information as they convey.  ‘Forgetting’ to include the person to whom the appendix belongs is a disrespectful teeter at the top of a slippery slide that most health care professionals would baulk at.  We react when people do this, we remind them that it is a person that is being discussed and that person should be respected.

Do we do the same in health care education? How much of our teaching meaningfully includes the patient perspective and experience?  We are very good at talking about patient-centred care in education but so little teaching is actually done by patients, or has patients as co-designers, or includes patient stories in an engaging and credible way.  The Health and Care Professions Council stipulate that service users and carers must be involved in pre-registration programmes ¹ but other regulators have not stipulated this.

Common methods of involving patients in education include direct face to face teaching with students and storytelling.

Frank² describes three types of story; restitution narratives that tell of an illness that has been treated and is resolved, quest narratives that report a patient’s journey and involve them overcoming a variety of obstacles, and chaos narratives that describe complex journeys with multiple, often unresolved issues.  These stories have the power to transform a learner’s understanding of illness, treatment, rehabilitation and recovery or readjustment.  Stories help us to understand patient priorities, which may be very different than our own.  And they help us to reflect on how the patient perceives our efforts to help. Stories can be told in many ways including face to face but often on video or even as a Facebook learning object³.

Face to face teaching takes a number of different formats.  Patients with training are employed to teach musculoskeletal assessment directly and achieve as good if not better results than their physician colleagues⁴.  Patients also engage in simulation, which means that students get to practice authentically – something that is highly valuable in terms of improving learning and helps to bridge the theory-practice gap⁵.  It has been demonstrated for example that standardised patients with intellectual disability are better able to support medics learning communication skills than actors trying to represent the complex and nuanced challenges the patients have⁶.

Patients gain a lot from being teachers.  One gentleman with MS who was engaged in classroom teaching with student nurses said ‘it was nice to get my two penneth in’⁷  because it wasn’t easy saying what you mean as a patient when you are in a position of dependence on the nurses.

Questions for the twitter chat:

1. What methods of involving patients in health education do you know of?
2. What do patients gain from being involved in health education?
3. What are the risks and costs for patients of their involvement?
4. What is the added value for students?

References

1. Health and Care Professions Council. Standards and Education and Training. London: HCPC, 2017.
2. Frank AW. The wounded storyteller: body, illness and ethics. Chicago: University of Chicago Press, 1997.
3. Ryan C, Wilson G, Dismore L, et al. Flo’s story: the development of a facebook learning object for health and social care students about persistent pain in older people. Pain and Rehabilitation – the Journal of the Physiotherapy Pain Association 2015;38:9-17.
4. Oswald AE, Bell MJ, Wiseman J, et al. The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students. BMC Medical Education 2011;11:65.
5. Rule AC. Editorial: the components of authentic learning. Journal of Authentic Learning 2006;3(1):1-10.
6. Thacker A, Crabb N, Perez W, et al. How (and why) to employ simulated patients with intellectual disabilities. Clinical Teacher 2007;4(1):15-20.
7. Costello J, Horne M. Patients as teachers? An evaluative study of patients’ involvement in classroom teaching. Nurse Education in Practice 2001;1(2):94-102.