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Involving patients in clinical teaching

Patients can be involved in teaching and learning in many ways throughout the whole curriculum cycle: planning, design/development, teaching and workplace learning sessions and activities, assessment strategies and methods, and evaluation/review. In this module, we focus specifically on where patients are directly or indirectly involved in teaching and learning.

Spencer and McKimm (2014) suggest a framework for discussing the involvement of patients in health professions education. The model is based around identifying Who? How? What? Where? and provides checklists against which patient involvement can be measured in a curriculum or in individual settings. These have been reproduced below.


Patients vary immensely in terms of their clinical (and social) problems, and also in their age, gender, ethnicity, sexual orientation, emotional and intellectual capacity and socio-economic status. Patients may be ‘real’ patients, simulated patients (or actors), ‘expert’ patients or technical simulators such as models or manikins (discussed in more detail later). Decisions need to be made by clinical teachers in consultation with patients and carers as to the appropriateness of involving patients in teaching. However, research into patient involvement highlights that the majority of patients benefit from being involved in teaching (Lefroy, 2008).


Learners working on a ward, in an ambulatory care setting, clinic, community setting or emergency department will have very different opportunities for encounters with patients. This will affect learning that can take place while the patient is present, the preparatory and follow-up learning, and the roles and expectations of teacher, patient and learner.

The list below provides a useful summary of the types of interaction that may be most relevant to achieve different learning outcomes for learners. Most attributes apply to all patients, but some (such as the novice or expert patient) will need to be planned with specific patients in mind.


Brief contact
Passive role
Time limited
Inexperienced (‘novice’)
Planned encounter
Simulated situation
Known patient
Focused learning
Tutor involved

Prolonged contact
Active role
Time committed
Experienced (‘expert’)
Unplanned encounter
Real situation
Unknown patient
Holistic learning
Tutor not involved



The location of the encounter (patients’ homes, community setting, roadside emergency, intensive care unit or oncology outpatient chemotherapy unit) has a huge impact on the patients’ and learners’ experiences, and the learning opportunities available. Settings may be very different, but equally valuable for facilitating the achievement of different learning outcomes.


‘Our place’
‘My culture’
‘My clothes’
Service setting

‘Your place’
‘Your culture’
‘Your clothes’
Educational setting


The ‘where’ also includes:

  • ‘real environment’ and ‘simulated environment’ – as training wards and simulation centres are increasingly being used in training health professionals
  • ‘uni-professional’ or ‘multiprofessional’ settings – to distinguish between clinical situations in which learners from one profession alone are learning with patients and those in which a range of health and social care professionals are learning and working.



Considering the sort of learning (the ‘content’) or clinical problems that the learner might encounter when working with different patients can help to tease out what specifically the learner is gaining from hearing from, examining and treating the patient.


Undifferentiated problem
High impact
Clinical science
Simple skills
‘Revealed’ attitudes
Particular focus

Defined problem
Low impact
Basic science
Complex skills
‘Hidden’ attitudes
Generic approach

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Further information

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Learning activities

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