Background and context
A report for the Health Foundation noted that ‘Interacting with people who experience health conditions or receive health and social care, or both, should be central to the education and training of the health professionals who will treat them’ (Spencer et al., 2011).
Health professions and services have come a long way since the days of patients being used as ‘teaching material’ or ‘the spleen in bed 4’. Osler’s (1904) quotation is very commonly cited in medicine: ‘For the junior student in medicine and surgery, it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself’ but a number of high profile inquiries and reports (including the Francis Report on the Mid-Staffordshire Inquiry, 2013) highlight the need for a shift in the relationships between health professionals, learners and patients towards patient-centred learning, a more active role for patients and involving patients as partners in the education process.
Florence Nightingale stated that ‘the very first requirement in a hospital is that it should do the sick no harm.’ And in this context, one of the main challenges for clinical teachers is to achieve a balance between ensuring good patient care and enabling the learner to acquire the skills, understanding and behaviours of an effective professional practitioner. A number of recent trends in healthcare are important in this regard:
- shifts in clinical care, such as less in-patient care with shorter stays in hospital: patients who are in hospital may be very ill, frail or have complex conditions
- more community-based care and diversification of provision, including third sector, private practice and user-led services
- increased student and learner numbers leading to reduced opportunities to learn from large numbers of patients
- patients more assertive about being ‘used’ as ‘teaching material’, especially by large numbers of different learners
- NHS organisations becoming more risk-averse and patient-focused
- care pathways and integrated care leading to reduced opportunities for learners to take histories and clerk patients
- changing roles of healthcare professionals have reduced learning opportunities in practice
- providing patient choice may lead to reduced opportunities for learning in the clinical setting
In the next sections we will explore how clinical teachers can meet some of these challenges through using alternative teaching and learning approaches while still ensuring the needs of both learners and patients can be met.