Patient involvement in primary care medical education: how might their active participation be enhanced?

Problem

The ‘patient’s voice’ is increasingly emphasized in educational strategies [1,2]. However, much of this has focussed on patients who have been recruited to have a primary educational role [3,4]. Students also benefit from contact with ‘real-time’ patients who have diverse health needs. The involvement of these patients does not usually extend to having an active part in the encounter. Evidence on how to promote their active involvement is limited.As undergraduate curricula evolve to incorporate more teaching in primary care, educators will increasingly need to draw on these real-time patients, and hence GPs need to know how best to actively involve their patients.This study aimed to identify ways to enhance the active involvement of real-time patients in undergraduate medical training in primary care.

Approach

A qualitative study was conducted involving a half-day workshop with patients (n=14), students (n=8), as well as GP tutors and faculty members (n=14) in Newcastle University. This included small group discussions, co-facilitated by researchers and patients, which considered practical solutions to barriers identified from research: consent practices, ambiguity among patients about their role, and opportunities for feedback. Data included transcripts from audio recordings and written notes on flip charts. These were analysed using reflexive thematic analysis. Codes were generated inductively and deductively and discussed with the research team. These were refined and organised into themes.

Findings

Patients may be encouraged to actively participate by raising awareness of medical education, enhancing practice processes, and developing patient roles during the teaching consultation.Raising patients’ awareness of medical education and students is essential to facilitate relationships and information exchange during teaching consultations. Patients need clear, relevant, and visible information materials, disseminated using various media which are accessible to a wide range of patients. Normalising teaching within general practice by including the word ‘teaching’ in the surgery name may encourage and prepare patients to actively participate.Enhancing the practice processes of involving patients in teaching is crucial to enhance their experiences and active roles. For instance, ensuring adequate consent practices that enable patients to make an informed choice makes them feel empowered and enhances the quality of interactions with students. Similarly, acknowledging their contributions makes them feel valued and encourages future participation.During teaching consultations, patients’ roles may be developed by inviting them to perform active roles and establishing good relationships.

Consequences

Real-time patients are invaluable to primary care teaching, but perhaps due to the hierarchical nature of medicine, need to feel empowered to educate students. Their role may be supported by enlightening them about medical education; enhancing the processes of seeking approval and acknowledging their contributions; establishing good relationships; and inviting them to actively participate. This study provides feasible and practical recommendations to enhance patients’ active involvement in primary care teaching.