Public Science Insights: 'Thank You for Giving Me a Voice!’ Evaluating the Patient-Centered Model in an Australian Medical School

Posted Wed, Mar, 22,2017


While patient involvement in medical education has long been the convention, in recent years patient involvement in student teaching has become more active. In medical education, active participation from patients has gained momentum despite being a fairly conventional practice. Medical education has always looked to patients to provide teaching. In the past, they may have been conscripted rather than consented into the role. There was a pervasive belief that patients receiving free care in public hospitals should return the favour by furthering the education of future doctors.

More recently, healthcare consumer advocacy has seen patients gaining autonomy and equality in relationships with hospitals and doctors. As care has become more patient-centerd, so too has medical education. Increasingly, patients are actively involved in roles from curriculum development to teaching, assessment, and even student selection.

There is a growing sense among some medical educators that a patient-centered model of learning should focus on the collaborative production of knowledge through patient-student dialogue, with educators acting only as a resource. This educational philosophy is underpinned by the idea that people with illnesses are the primary source material or ‘text' of medicine and that the main concern of medicine, is first and foremost, to help patients.

Rather counterintuitively, however, there is strong evidence that as medical students progress through their training, the gap between them and patients widens. Students become less empathic, less idealistic, and less concerned with the social aspects of health as they become enculturated to the objectivity required by traditional educational models.

It was this apparent disconnect that drove the development of the longitudinal patient-partner program described in our recent paper, "Thank you for giving me a voice!" A longitudinal evaluation of patients' experience of partnering with students in an Australian medical school. Our method was to pair students in their clinical years with people living with chronic disease to encourage a better understanding of the patient's lived experience and social context over time. Our hope was that the program would open students' eyes to the complexities of life people deal with day-to-day that impact on their ability to perform the management agendas created by their clinicians. Our ambition was to create patient-centred clinicians who would challenge entrenched systems and practices that alienate people from effective care.
Patients loved it. They were willing participants and felt their time was well invested in improving the future for themselves, the health system, and the students. There were also lightbulb moments for many students. Sadly, our data also further supported the evidence that some students were disinterested in learning from the patients they will ultimately care for, preferring teaching offered by tutors and textbooks. That disinterest manifests as poor forward planning of meetings, frustration with patients who failed to meet the student's needs, failing to communicate effectively, and not providing appropriate information. In short, many of the failings patient advocates already identify as entrenched in the healthcare system.

What patients bring willingly to medical education is a priceless gift: their time, their experiences, their bodies, their vulnerabilities. No actor or simulation technology can ever completely replace it. But in the age of consumer power, both medical educators and students must acknowledge that this is a gift, not a right, and pay due respect to the contribution of patient-partners to better health care for all.

Dr Kimberly Ivory is the author of the recently published paper 
"Thank you for giving me a voice!” A longitudinal evaluation of patients’ experience of partnering with students in an Australian medical schoolavailable for download now in Journal of Medical Education and Curricular Development.

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