2015, 37: 94–96

SHORT COMMUNICATION

Patient experiences of participation in a medical student teaching workshop LAURA WATTS1, TESS MCPHERSON2, JOANNA ROBSON1, GEORGE RAWLINGS2 & SUSAN BURGE2 1

University of Oxford, UK, 2Churchill Hospital, UK

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Abstract Objectives: To investigate the motivations for and experiences of patients who actively participate in a workshop to teach medical students about chronic disease. Design: Descriptive study using structured telephone or e-mail-based questionnaire exploring the views of ‘patient tutors’ who participate in a ‘living with chronic disease’ workshop. Participants: ‘Patient tutors’ with a chronic medical condition who had participated in at least one ‘living with chronic disease’ workshop for medical students at Oxford University Medical School. Results: Patient motivating factors can be divided into two groups, direct benefits such as companionship or improved knowledge of their condition, and a teaching role involving an altruistic desire to give something back, and wanting to educate the doctors of the future. Importantly, most patients participated multiple times over a number of years despite no remuneration for their time other than expenses. Conclusions: Patients appear highly motivated to educate medical students about chronic disease, due to a combination of personal benefits and an altruistic desire to ‘give something back’. This suggests that they present an invaluable and currently undermobilized resource for the future of medical education.

Introduction Putting the patient at the heart of service delivery is recognized as a vital part of medical care. Patient and public involvement (PPI) in all aspects of care is highlighted in the General Medical Council’s guidance to all UK doctors, where the duties of a doctor include the ability to ‘‘work in partnership with patients’’ and working to ‘‘support patients in caring for themselves’’ (General Medical Council 2013). One way that this can be achieved is via more active involvement of patients in teaching, and greater patient involvement is a theme of ‘Tomorrow’s Doctors’, which sets standards for medical education in the UK (General Medical Council 2009). However, there is still much work to be done to understand how PPI can best be used to benefit patients and students. Patients are increasingly involved in teaching and assessment. This has received positive feedback from students and appears of equivalent quality to that provided by doctors (Pickard et al. 2003; Raj et al. 2006; Phillpotts et al. 2010; LongBellil et al. 2011). However, studies are limited on the experiences of patients who participate in teaching and have often been on the presence of students in consultations, rather than a specific patient delivered teaching programme. Nevertheless, patients appear satisfied with seeing and teaching medical students (Haffling & Ha˚kansson 2008; Mol et al. 2011) and may derive benefits including feelings of altruism, giving something back, improved knowledge, and

longer consultation time (Coleman & Murray 2002; Mol et al. 2011). We have over 10 years experience of collaborating with patients as tutors in a ‘‘Living with chronic disease’’ workshop at Oxford University Medical School. Our ‘patient tutors’ share their experiential based knowledge of the realities of living with a chronic condition with medical students and many regularly participate over a number of years, despite no remuneration other than expenses. We hypothesized that they may be deriving benefits from teaching such as feelings of altruism or improved knowledge about their condition, and sought to explore their views on this further.

Methods Participants were identified from a database of patient tutors who had participated in at least one workshop (n ¼ 28). They were invited to complete a 10-min telephone or e-mail questionnaire involving numerical, yes/no or five-point Likert scale responses, followed by comments. No funding was required and no formal ethical approval was needed as it met the criteria for a service evaluation/audit.

Results Responses were obtained from 16/22 participants with up to date contact details. Three declined to participate and two

Correspondence: Laura Watts, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, United Kingdom. E-mail: [email protected]

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ISSN 0142-159X print/ISSN 1466-187X online/15/010094–3 ß 2015 Informa UK Ltd. DOI: 10.3109/0142159X.2014.947946

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Patient experiences of a teaching workshop

failed to complete the online questionnaire. One was excluded as a co-author. Half had been participating for more than four years and only one had been participating for less than two years. All had participated more than once (many more than ten times) and would be willing to participate again if time allowed. Patients were positive about participation in the workshop. 11/16 disagreed or strongly disagreed that the time commitment was a negative aspect and most did not have difficulty discussing personal or sensitive topics. 12/16 felt that attitude of the students was not a negative aspect; however, comments suggested that there may have been some problems in a couple of workshops. All participants agreed or strongly agreed that ‘‘wanting to give something back’’ was a motivating factor and 13/16 agreed or strongly agreed that they were motivated by a desire to influence the doctors of the future. One patient clearly stated that he took part as ‘‘I had been wrongly diagnosed for 30 years and didn’t want anything to be missed again’’. Other motivations included wanting to learn more about their condition (10/16 agreed or strongly agreed) that the workshop ‘‘familiarized me with the local hospital’’ and reduced loneliness and isolation. Two key benefits the participation were the opportunity to ‘give something back’ (14/16 agreed or strongly agreed) and to ‘raise awareness of neglected aspects of the medical condition’ (15/16 agreed or strongly agreed initially, 14/16 still agree this is a benefit). 10/16 also agreed or strongly agreed with respect to their first workshop that they were given an opportunity to influence the doctors of the future. Personal benefits included the opportunity for discussion at greater length than in a standard medical consultation (8/16 agreed or strongly agreed) and to see how the condition affects others (12/16 agreed or strongly agreed).

Discussion The long running ‘Living with chronic disease’ workshop at Oxford University provides a unique environment through which to study how patients with chronic diseases interact with medical students. Our study confirmed previously identified direct benefits to patients of teaching, companionship and improved knowledge about their condition (Coleman & Murray 2002). We have also shown that our ‘patient tutors’ felt that they could both be examples of their condition and help to shape attitudes towards future patients. This teaching role is motivated by an altruistic desire to ‘give something back’ for the care they have received and also influence the doctors of the future, sometimes to prevent others receiving care that they feel has been substandard. Previous studies have suggested that patients may have difficulty sharing sensitive information (Howe & Anderson 2003; Haffling & Ha˚kansson 2008; Mol et al. 2011) and may also develop ‘patient fatigue’, where they are unwilling to repeatedly give up their time to teach. Only one of our participants reported any difficulty with discussing sensitive

topics and all our tutors participated multiple times over many years and would be willing to participate again. Limitations include the small number of participants and low response rate. Potential biases include those who derived benefits being more likely to respond and recollection bias from patients being asked retrospectively about initial motivations for participating. Future focus may be on following those who only participated once or who did not derive benefits. We have shown that patient tutors are highly motivated to collaborate in the teaching of medical students. Whilst our group are those who have specifically given up their time to participate in this workshop, similar benefits may also be expected from more opportunistic teaching. We have demonstrated that patients both derive direct benefits such as meeting others with the condition, but also feel good about performing a teaching role and sharing their experiences to help to educate the doctors of the future.

Notes on contributors LAURA WATTS, BA, BMBCh, MRCP, is a Junior Doctor, Academic Clinical Fellow in Rheumatology and teaches medical students in Oxford. TESS MCPHERSON, MA, MBBS, MRCP, MD, is a Consultant Dermatologist and Clinical Lecturer in Oxford. Special interests include medical education (Clinical tutor for dermatology course) inflammatory skin disease, paediatric dermatology, and psychodermatology. JOANNA ROBSON, MBBS, PhD, MRCP, is an NIHR Clinical Lecturer in Rheumatology at the University of Oxford. Projects: developing an ANCAassociated vasculitis (AAV)-specific patient reported outcome measure, defining the risk of developing aortic aneurysm in GCA, and chairing the ACR/EULAR Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study committee. GEORGE RAWLINGS is a longstanding member and Secretary of the Oxford group for the Psoriasis Association. He gives ‘‘Living with Psoriasis’’ talks to student nurses and has been an ‘‘Expert patient’’ for workshops for trainee Doctors at the John Radcliffe Hospital over many years. SUSAN BURGE, OBE, BSc, BM, DM, FRCP, is Foundation Training Programme Director, Oxford Deanery; Hon Consultant Dermatologist, Oxford University Hospitals NHS Trust and has previously been Director of Clinical Studies at Oxford University.

Declaration of interest: L. W. declares previously working on a research project partially funded by GlaxoSmithKlein, which had no relationship to the current work. The other authors report no declarations of interest.

References Coleman K, Murray E. 2002. Patients’ views and feelings on the communitybased teaching of undergraduate medical students: A qualitative study. Fam Pract 19(2):183–188. General Medical Council. 2013. Good Medical Practice. London: GMC. General Medical Council. 2009. Tomorrow’s Doctors. London: GMC. Haffling AC, Ha˚kansson A. 2008. Patients consulting with students in general practice: Survey of patients’ satisfaction and their role in teaching. Med Teach 30(6):622–629. Howe A, Anderson J. 2003. Involving patients in medical education. BMJ 327(7410):326–328. Long-Bellil LM, Robey KL, Graham CL, Minihan PM, Smeltzer SC, Kahn P, Alliance for Disability in Health Care Education. 2011. Teaching

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medical students about disability: The use of standardized patients. Acad Med 86(9):1163–1170. Mol SS, Peelen JH, Kuyvenhoven MM. 2011. Patients’ views on student participation in general practice consultations: A comprehensive review. Med Teach 33(7):e397–e400. Phillpotts C, Creamer P, Andrews T. 2010. Teaching medical students about chronic disease: Patient-led teaching in rheumatoid arthritis. Musculoskeletal Care 8(1):55–60.

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Patient experiences of participation in a medical student teaching workshop.

To investigate the motivations for and experiences of patients who actively participate in a workshop to teach medical students about chronic disease...
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