Faculty Development

‘Patients should be involved at all stages of training to explain and portray the patient journey (patient)’ (PMETB, 2008, p. 7).

Most research into patient views on being involved in clinical teaching emphasises the positive nature of the encounter and ‘even unprepared patients see themselves as contributors to teaching’ (Haffling and Håkasson, 2008, p. 622). Patients see themselves as experts in and examplars of their condition and as facilitators of learning, particularly in professional skills and attitudes (Stacey and Spencer, 1999).

Empowering patients includes providing ‘opportunities for communication and input, being asked for their consent; having their feedback valued and an open and approachable attitude from the person in power (usually the tutor)’ (Howe and Anderson, 2003, p. 327).  

Benefits cited by patients include:

• feelings of altruism and helpfulness
• ‘repaying the system’
• learning more about their clinical condition or problem
• being given more time and attention by clinicians – a better service
• being valued and enhancing self-esteem
• companionship and relief for social isolation (e.g. community visits to elderly patients living alone)
• reassurance of wellbeing (‘a good going over’)

(Coleman and Murray, 2002; Howe and Anderson, 2003; O’Flynn et al., 1997)

However, patients feel that participation in teaching has to be considered carefully and sensitively. Factors that cause patients to feel reluctant to participate in clinical teaching include the following.

• Feeling embarrassment or anxiety about emotional problems or intimate examinations.
• Learners’ gender or other cultural factors, for example male students being involved in gynaecological or obstetric procedures and consultations (O’Flynn and Rymer, 2002).
• Previous poor experiences with learners.
• When there are relatively large numbers or less-experienced learners.
• When the consultation or encounter is ‘high stakes’ (such as birth, being given bad news, a difficult, painful or sensitive examination or procedure).
• Repeated contact with doctors and learners can also reinforce feelings of ill health and emphasise the medicalisation of health issues (Coleman and Murray, 2002). 

Benson et al. also identified that patients perceive differences between what they might accept as the norm in hospital (where things might have to be accepted as the ‘norm’) and in general practice, which is seen more as the ‘patients’ territory’ (2005, p. 4).