What sort of patient? Real patients in real clinical areas
Patients can be actively involved in teaching in various ways, from real encounters in real-life situations to simulations and videoed patient ‘stories’. Over the next few sections, we describe some of the commonly used methods.
Real patients in real clinical areas
One of the real benefits to learners in working with real patients in the clinical context is for learners to consolidate and synthesise their learning from a range of sources. Most health professional undergraduate programmes have early ‘blocks’ in the university where students acquire knowledge, skills and professional behaviours and then they work on wards, clinics and other settings where they put this into practice and learn more.
Whenever and wherever clinical teaching occurs, because of power dynamics, real patients are usually the most vulnerable of the three parties involved (in the traditional triad of teacher, learner and patient). Most patients find clinical teaching extremely rewarding, often commenting that they feel students ‘have to learn’, but the patient’s attitude towards being involved in teaching should always be respected and it should be reinforced that, whether they choose to participate or not, it will not affect their treatment and care. Within any clinical education setting, patients must be made explicitly aware (through notices and signage as well as conversation) that the facility is a learning and teaching environment, that learners may be present and in some cases they will provide care. Although quite often, for example in the case of student nurses providing daily care such as bathing or dressing, patients may not be explicitly aware that the learner is ‘learning’ on them, in other cases, the learner will be carrying out a procedure (e.g. catheterisation) for the first time with a real patient. Patients need to be informed and have opportunities to prepare for the encounter and raise any concerns or anxieties they may have. At all times, the patient needs to be kept informed, mutual agreement needs to be reached about the session and, most importantly, patient privacy and dignity must be maintained.
While using real patients for teaching in clinical areas is often opportunistic (based on who is on the ward or attending the clinic or surgery), simulated patients and trained real patients, such as lay clinical educators, patient educators or teaching associates, are increasingly being employed.