Patient participation in medical education (PatMed): a qualitative study of patient and student experiences of undergraduate medical education in general practice, developing findings of a systematic review

Problem

In 2015, we published a BEME systematic review of undergraduate medical education in the UK general practice setting. This included a meta-ethnographic synthesis of qualitative papers which produced two models: general practice practice as a socio-cultural space for learning; and interpersonal interactions within the teaching consultation. This second study, explored and developed these findings with patients and medical students.

Approach

We conducted 2 medical student focus groups and 9 in-depth interviews with patients with experience of general practice teaching consultations. Focus groups and interviews began with open-ended questions, then invited comments on the two meta-ethnography models. Transcripts were analysed iteratively and coded thematically. These themes were developed into a thematic framework. We compared how themes agreed, disagreed and overlapped between the student and patient groups, then examined agreement and dissonance between this data and our meta-ethnography models.

Findings

While there were many areas of agreement, we focus here on areas of development. Our original model positioned the GP as 'broker' of triadic interactions between GP, patients and students. PatMed shows that relationships and brokering roles can shift with time and experience: senior medical students brokering teaching encounters, and patients taking on roles as 'educator', framing them as a legitimate member of the teaching consultation. Consent was identified as a pivotal moment for re-negotiating these positions. Our model of socio-cultural spaces of learning positioned hospital and general practice as polarised spaces, leaving the student to negotiate competing cultures. In PatMed, students described general practice as a space to put conceptual learning into practice. In the meta-ethnography, general practice was described as a 'fact-free' space. This was refuted in PatMed, students describing general practice as a space to learn about common things and medicine that reflects society.

Consequences

PatMed has affirmed many concepts developed from our meta-ethnographic synthesis of literature, and allowed us to refine and develop models further. Patients, students and GPs are all implicated in a dynamic re-negotiation of power within teaching consultations. We will discuss the application of these findings for GPs involved with undergraduate teaching.