Faculty Development

Patients can be involved in clinical teaching in many ways throughout the whole curriculum cycle: planning, design/development, teaching and workplace-based learning sessions and activities, assessment strategies and methods, and evaluation (Gordon et al., 2000).

See other e-learning modules and ‘Other resources’ papers for specific ideas around these aspects. In this module, we focus specifically on where patients are directly or indirectly involved in teaching and learning.

Spencer et al. (2000) reviewed the role of the patient in clinical teaching and learning and suggested a framework for discussing the involvement of patients in medical education. The model is based around identifying Who? How? What? Where? and provides checklists against which patient involvement can be measured in a curriculum or in individual settings. These have been reproduced below.

Who

Patients vary immensely in terms of the clinical problems with which they present, and also in their age, gender, ethnicity, sexual orientation, emotional and intellectual capacity and socio-economic status. Patients may be ‘real’ patients, simulated patients (or actors), ‘expert’ patients or simulators such as models or manikins (discussed in more detail later in the module). Decisions need to be made by clinical teachers in consultation with patients and carers as to the appropriateness of involving patients in teaching. However, research into patient involvement highlights that the majority of patients benefit from being involved in teaching (Lefroy, 2008; Haffling and Håkansson, 2008).

How

Trainees and students working on a ward, in an outpatient clinic, GP consultation or emergency department will have very different opportunities for encounters with patients. This will affect learning that can take place while the patient is present, the preparatory and follow-up learning, and the roles and expectations of teacher, patient and learner.

The list below provides a useful summary of the types of interaction that may be most relevant to achieve different learning outcomes for learners. Most attributes apply to all patients, but some (such as the novice or expert patient) will need to be planned with specific patients in mind.

Where

The location of the encounter (patients’ homes, GP practice, intensive care unit or oncology outpatient chemotherapy unit) has a huge impact on the patients’ and learners’ experiences, and the learning opportunities available. Settings may be very different, but equally valuable for facilitating the achievement of different learning outcomes.

The ‘where’ also includes:

• ‘real environment’ and ‘simulated environment’ – as training wards and simulation centres are increasingly being used in training health professionals
• ‘uni-professional’ or ‘multiprofessional’ settings – to distinguish between clinical situations in which doctors alone are learning with patients and those in which a range of health and social care professionals are learning and working.

See the module Facilitating learning in the workplace for ideas about planning learning opportunities in different settings and the ‘Other resources’ papers for ideas in the operating theatre, outpatient clinic, community, consultation and bedside teaching contexts.

What

Considering the sort of learning (the content) or clinical problems that the trainee might encounter when working with different patients can help to tease out what specifically the learner is gaining from hearing from and examining the patient.