The patients’ perspective
Most research into patient views on being involved in health professions teaching emphasises the positive nature of the encounter with even unprepared patients seeing themselves contributing to teaching and learning. Patients see themselves as experts in and exemplars of their condition and as facilitators of learning, particularly in professional skills and attitudes (Spencer and McKimm, 2014).
Empowering patients includes providing time and opportunities for communication and input; ensuring the room layout, state of dress or activities maintain dignity; being asked for consent; having feedback and opinion valued and an approachable, non-patronising attitude from the person in power, usually the teacher.
Benefits cited by patients include:
- feelings of altruism and helpfulness
- repaying the system, giving back
- learning more about their clinical condition or problem
- being given more time and attention by practitioners – a better service
- being valued and enhancing self-esteem
- companionship and relief for social isolation (e.g. community visits to older patients living alone)
- reassurance of wellbeing through a comprehensive encounter.
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
- 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 primary care, which is seen more as the ‘patients’ territory’ (2005, p. 4).
This can be compounded when teachers from the different professions have responsibility for their own learners but are not aware of the activities of others. For example, a busy medical ward might have a large number of medical, nursing and physiotherapy students as well as postgraduate learners (doctors in training, respiratory therapists, advanced practitioners, etc.). A patient with suspected pneumonia or dementia may well have a history taken, and be examined and treated by all these learners at some point (each of whom has a legitimate need to learn from and with the patient) so it is important to ensure that some gatekeeping occurs to ensure the patient is respected and well cared for.