Guiding Principles for Patient and Public Engagement in the Educational Missions of Medical Schools.

PURPOSE: The purpose of this research was to cocreate with patients and the public a set of evidence-informed guiding principles for their authentic, responsive, ongoing, and sustainable engagement in the mission, goals, curriculum, and delivery of medical education. METHOD: A set of guiding principles of relevance to medical education was identified from the literature. Eight focus groups with patients and community members representing a wide variety of perspectives were conducted in April and May 2022. Participants reviewed, prioritized, and discussed the principles and described successful engagement, resulting in 8 guiding principles in priority order. A summary report was circulated to participants for feedback. The principles were reviewed and endorsed by senior leaders in the medical school. RESULTS: The 8 focus groups were attended by 38 people (age range, mid-20s to postretirement; 7 male, 27 female, and 4 unknown gender). Accountability (19%), inclusion (18%), reciprocity (17%), and partnership and shared decision-making (14%) were chosen as the most important principles. They want evidence that their contributions are valued and have made a difference. They want the medical school to include and support a diversity of perspectives that reflect the populations being served by the health care system. They want the medical school to invest in building trusting and respectful long-term relationships with patients and the public. CONCLUSIONS: The guiding principles could be used by medical schools as a starting point to build relationships with their local communities to increase the authentic and sustainable engagement of patients and the public in the educational mission of the medical school.

Expanding access to healthcare for people who use drugs and sex workers: hepatitis C elimination implications from a qualitative study of healthcare experiences in British Columbia, Canada.

BACKGROUND: Hepatitis C virus (HCV) is a major health threat in Canada. In British Columbia (BC) province, 1.6% of the population had been exposed to HCV by 2012. Prevalence and incidence of HCV are very high in populations of people who use drugs (PWUD) and sex workers (SW), who may experience unique barriers to healthcare. Consequently, they are less likely to be treated for HCV. Overcoming these barriers is critical for HCV elimination. This research sought to explore the healthcare experiences of PWUD and SW and how these experiences impact their willingness to engage in healthcare in the future, including HCV care. METHODS: Interpretive Description guided this qualitative study of healthcare experiences in BC, underpinned by the Health Stigma and Discrimination framework. The study team included people with living/lived experience of drug use, sex work, and HCV. Twenty-five participants completed in-depth semi-structured interviews on their previous healthcare and HCV-related experiences. Thematic analysis was used to identify common themes. RESULTS: Three major themes were identified in our analysis. First, participants reported common experiences of delay and refusal of care by healthcare providers, with many negative healthcare encounters perceived as rooted in institutional culture reflecting societal stigma. Second, participants discussed their choice to engage in or avoid healthcare. Many avoided all but emergency care following negative experiences in any kind of healthcare. Third, participants described the roles of respect, stigma, dignity, fear, and trust in communication in healthcare relationships. CONCLUSIONS: Healthcare experiences shared by participants pointed to ways that better understanding and communication by healthcare providers could support positive change in healthcare encounters of PWUD and SW, who are at high risk of HCV infection. More positive healthcare encounters could lead to increased healthcare engagement which is essential for HCV elimination.

Patient/public perceptions on engagement with a medical school: What needs to happen to support authentic and sustained participation.

PURPOSE: Patient/public involvement in health professional education is increasing but remains episodic, narrowly focused, reliant on individual enthusiasts, and lacks supportive institutional infrastructure. There is little evidence-informed practical guidance on how to take a more strategic and formal approach. We undertook a qualitative study to learn from patients and the public how medical schools could engage in an authentic and sustainable way. METHODS: In 2022 we conducted eight focus groups with patients and members of community organizations. Participants were asked about experiences and perceptions of what needs to happen to enable and support them to participate in medical education, barriers to authentic engagement, and how they might be overcome. Recordings were transcribed and data coded inductively. A summary report was circulated to participants for validation of findings. RESULTS: The focus groups were attended by 38 participants representing a wide variety of perspectives. Participants provided practical suggestions that we categorized into six major themes: inviting participation; preparing for participation; supporting participation; increasing and supporting diversity; recognizing participation; institutional buy-in and support. CONCLUSIONS: Individual instructors can enhance authentic patient engagement through recruitment, support and recognition practices. Institutional commitment is required to sustain and widen participation through funding, policies and infrastructure.

Patients benefit from mentoring students in an interprofessional health mentors program: A contextual-developmental analysis.

PURPOSE: Mentorship programs in health professional education are often characterized as a mutually beneficial relationship between mentor and mentee, but little is known about benefits for mentors. Mentors can be health professionals, academic faculty, other students (peers), and patients (health mentors). We studied the benefits that health mentors (people with chronic health conditions or disabilities, or a caregiver) get from mentoring students, and the contextual factors that contribute to, or explain these benefits. METHODS: We surveyed 72 health mentors who had mentored between one and eight cohorts of students from different health professions in the health mentors program at the University of British Columbia. Using a contextual-developmental framework of mentorship, we analyzed mentors' responses to open-ended questions about how they benefit from the program. RESULTS: Benefits fit into three categories: generativity (guiding the next generation), transformation (personal growth and reflection), and 'career' development (new activities resulting from increased self-efficacy). Contextual factors that contributed to benefits included the non-clinical setting, informality of meetings and reciprocal learning, and feeling valued by the program and students. CONCLUSIONS: Health mentors perceive benefits in passing on their lived experiences to students, leading to personal growth and new activities. Their perspectives offer unique insights into the workings of effective mentorship relationships. There is much to be learned about how benefits of mentoring are linked to program design.

Patient Partners in Continuing Professional Development: Experience Developing an End-of-Life Care Program for Family Physicians.

ABSTRACT: Involvement of patients in continuing professional development (CPD) is less developed than in health professional education at undergraduate or postgraduate levels. Although patients are sometimes involved in delivering CPD, they are less likely to be involved in education planning. At our institution, patients have sometimes acted as consultants in the design of CPD. The problem we address is how to engage patients as partners throughout the design process. We applied principles of authentic patient engagement and lessons learned from patient involvement in undergraduate health professional education to the design of CPD for family physicians. We created a partnership between the CPD Office and Patient and Community Partnership for Education, a unit with a history of patient involvement in the education of health professional students. Practices for meaningful involvement were identified through literature review, environmental scan, and interviewing key informants, including patients involved in health professional education at the university. These principles and practices were applied to the development of a CPD module on end-of-life care. Patient partners contributed new perspectives and some CPD providers reassessed components of their own practice as a result. Lessons learned include the need for stakeholder buy-in; mechanisms to identify those patients best able to contribute expertise; ways to facilitate involvement that work for both patients and CPD providers; the importance of feedback mechanisms to patient partners; and recognition for patient contributions. CPD offices should view integration of patient partners in program planning as an opportunity to engage in ongoing quality improvement.

Deaf and hard of hearing awareness training: A mentor-led workshop.

BACKGROUND: People who are deaf and hard of hearing (DHH) comprise a significant and increasing proportion of the population. They face many barriers to accessing good health care and major communication challenges with health professionals. There is evidence that DHH awareness training for health professionals needs improvement but little information about how such training is incorporated into curricula. The research question we address is how to develop and deliver an effective workshop for students led by people who, by definition, have barriers to communication due to hearing loss and deafness. METHODS: Workshop development was initiated and led by a medical student as a course project, in collaboration with DHH people, other students, and university faculty in an iterative participatory educational design process, supported by a community-based organization that provides programs and services for DHH people. Development resulted in a pilot workshop suitable for all health professional students. RESULTS: Three workshops were attended by a total of 49 students from 10 different health disciplines. Workshops were highly rated. Thematic analysis of post-workshop reflections written by occupational therapy students showed learning in the domains of knowledge, skills (practical tips and techniques), and attitudes (assumptions, motivation, reflection). CONCLUSIONS: Partnership with a community organization makes it feasible for DHH people to design and facilitate workshops. The organization can provide the necessary environment, technology, and support, and identify people with lived experience to be workshop mentors. Workshops help make students more aware of the needs of DHH people and motivate them to provide better care.

Professional Identity Formation: A Role for Patients as Mentors.

PURPOSE: Medical education should foster professional identity formation, but there is much to be learned about how to support learners in developing their professional identity. This study examined the role that patients can play in supporting professional identity development during the University of British Columbia Interprofessional Health Mentors Program (HMP), a longitudinal preclinical elective in which patients, or their caregivers, act as mentors and educate students about their lived experience of a chronic condition or disability. METHOD: The authors interviewed 18 medical residents in 2016, 3 to 4 years after they completed the HMP. Professional identity was explored by asking participants how the HMP had influenced their ideas about the ideal physician and the kind of doctor they aspire to become. The authors analyzed the data using the identify status paradigm as a conceptual framework. RESULTS: The authors identified 7 themes: patient as more than disease, patient as autonomous, patient as expert, doctor as partner, doctor as collaborator, self-aware doctor, and empathic doctor. They found firm commitments to patient partnership, interprofessional collaboration, and holistic care for patients rooted in the exploration of professional values that was prompted by patient mentors during HMP. CONCLUSIONS: Patient mentors can help medical students begin to construct their professional identity during the preclinical period by supporting exploration of and commitment to the professional values that society expects of physicians.

Patients and students co-develop a resource database.

BACKGROUND: Health professional students are provided with a wealth of online learning resources recommended by curriculum developers or instructors, the majority of which focus on biological and clinical science. Our goal was to develop a database of learning resources to help students and faculty members understand chronic health conditions from a patient's perspective. Resources were recommended by patients and evaluated by students. Our goal was to develop a database of learning resources … recommended by patients and evaluated by students METHODS: Patients and caregivers who recommend resources to their students in an interprofessional health mentors programme, and participants in a Disability Learning Resource planning session, provided 68 different resources, ranging from community organisation websites to personal biographies. Resources were organised into eight categories and rated by 10 senior health professional students. Patients … provided 68 different resources, ranging from community organisation websites to personal biographies RESULTS: Patients recommended resources so that students could learn what it is like to live with a particular condition, and also learn about useful patient information resources and community-based advocacy organisations. Students identified 40% of the rated resources as useful or exceptionally useful, and identified the characteristics of useful and not useful resources. Students identified 40% of the rated resources as useful or exceptionally useful … CONCLUSIONS: Students want resources that are easy to navigate and are well organised. They want a 'one-stop shop' to access information about a particular condition or disease, and value resources that they can recommend to their patients as well as use to expand their own knowledge. Students value information about local organisations for specific conditions that they can connect their patients to, and from which they may learn more about existing support initiatives in their communities. Clinical educators could better prepare students for practice by making available patient-recommended resources. Students … value resources that they can recommend to their patients as well as use to expand their own knowledge Students value information about local organisations for specific conditions that they can connect their patients to … Clinical educators could better prepare students for practice by making available patient-recommended resources.

The regional medical campus model and rural family medicine practice in British Columbia: a retrospective longitudinal cohort study.

BACKGROUND: Regional medical campuses have been implemented across North America to address gaps in the physician workforce. We report findings from a study that examined the association between a combined model of regional medical campuses and students' decision to enter rural family medicine practice. METHODS: In 2004, the University of British Columbia added 2 regional medical campuses, 1 in a large population centre in a rural and coastal context and 1 in a medium-sized population centre in an isolated northern and rural context. Data were extracted from the University of British Columbia's Medical Education Database. Multivariable logistic regression examined the relationship of age, sex, rural background and campus location to students' choice of rural family medicine practice. RESULTS: There was an association between campus location and choice of family medicine versus other specialties. A rural background (odds ratio [OR] 2.59, 95% confidence interval [CI] 1.08-6.21) and training at either of the 2 regional medical campuses (OR 3.24, 95% CI 1.19-8.83 and OR 5.38, 95% CI 2.24-12.91) predicted rural family practice. INTERPRETATION: Choosing to practise family medicine in a rural location was associated with having a rural background and having trained at a regional medical campus. These early results suggest that a combined regional campus model in medical education contributes to the rural family practice workforce.

How patient educators help students to learn: An exploratory study.

INTRODUCTION: Benefits of the active involvement of patients in educating health professionals are well-recognized but little is known about how patient educators facilitate student learning. METHOD: This exploratory qualitative study investigated the teaching practices and experiences that prepared patient educators for their roles in a longitudinal interprofessional Health Mentors program. Semi-structured interviews were conducted with eleven experienced health mentors. Responses were coded and analyzed for themes related to teaching goals, methods, and prior experiences. RESULTS: Mentors used a rich variety of teaching methods to teach patient-centeredness and interprofessionalism, categorized as: telling my story, stimulating reflection, sharing perspectives, and problem-solving. As educators they drew on a variety of prior experiences with teaching, facilitation or public speaking and long-term interactions with the health-care system. CONCLUSIONS: Patient educators use diverse teaching methods, drawing on both individualistic and social perspectives on learning. A peer-support model of training and support would help maintain the authenticity of patients as educators. The study highlights inadequacies of current learning theories to explain how patients help students learn.

The community comes to campus: the Patient and Community Fair.

BACKGROUND: Community-based learning connects students with local communities so that they learn about the broad context in which health and social care is provided; however, students usually interact with only one or a few organisations that serve a particular population. One example of a community-based learning activity is the health fair in which students provide health promotion and screening for local communities. CONTEXT: We adapted the health fair concept to develop a multi-professional educational event at which, instead of providing service, students learn from and about the expertise and resources of not-for-profit organisations. INNOVATION: The fair is an annual 1-day event that students can attend between, or in place of, classes. Each community organisation has a booth to display information. One-hour 'patient panels' are held on a variety of topics throughout the day. Evaluation methods include questionnaires, exit interviews and visitor tracking sheets. Over 5 years (2009-2013), the fair increased in size with respect to estimated attendance, number of participating organisations, number of patient panels and number of students for whom the fair is a required curriculum component. Students learn about a range of patient experiences and community resources, and information about specific diseases or conditions. IMPLICATIONS: The fair is an efficient way for students to learn about a range of community organisations. It fosters university-community engagement through continuing connections between students, faculty members and community organisations. Lessons learned include the need for community organisations to have techniques to engage students, and ways to overcome challenges of evaluating an informal 'drop-in' event. The fair is an efficient way for students to learn about a range of community organisations.

"How to do things with words" in health professions education.

This paper reports on a qualitative study of journal entries written by students in six health professions participating in the Interprofessional Health Mentors program at the University of British Columbia, Canada. The study examined (1) what health professions students learn about professional language and communication when given the opportunity, in an interprofessional group with a patient or client, to explore the uses, meanings, and effects of common health care terms, and (2) how health professional students write about their experience of discussing common health care terms, and what this reveals about how students see their development of professional discourse and participation in a professional discourse community. Using qualitative thematic analysis to address the first question, the study found that discussion of these health care terms provoked learning and reflection on how words commonly used in one health profession can be understood quite differently in other health professions, as well as on how health professionals' language choices may be perceived by patients and clients. Using discourse analysis to address the second question, the study further found that many of the students emphasized accuracy and certainty in language through clear definitions and intersubjective agreement. However, when prompted by the discussion they were willing to consider other functions and effects of language.

Shifts in the interpretation of health advocacy: a textual analysis.

CONTEXT: Health advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the health advocate and what these reveal about its interpretation and enactment within the context of medical education. METHODS: We conducted a textual analysis of three key documents that provide sequential depictions of the role of the health advocate in medical education frameworks: Educating Future Physicians for Ontario (1993), CanMEDS 2000 and CanMEDS 2005. We used a series of questions to examine shifts in the emphasis, focus and application of the role between documents. Theoretically, we drew upon Carlisle's conceptual framework to identify different approaches to advocacy. RESULTS: We identified three major shifts in the language associated with the role of health advocate across our textual documents. Firstly, activities and behaviours that were initially positioned as being the responsibility of the profession as a whole came to be described instead as competencies required of every physician. Secondly, the initial focus on health advocacy as representing collective action towards public policy and systems-level change was altered to a primary focus on individual patients and doctors. Thirdly, we observed a progression away from descriptions of concrete actions and behaviours. CONCLUSIONS: This study uncovers shifts in the language of physician advocacy that affect the discourse of health advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of health advocacy in medicine and medical education globally.

The expert patient as teacher: an interprofessional Health Mentors programme.

BACKGROUND: To meet future health care needs, medical education must increase the emphasis on chronic illness care, interprofessional teamwork, and working in partnership with patients and families. One way to address these needs is to involve patients as teachers in longitudinal interprofessional educational programmes grounded in principles of patient-professional partnerships and shared decision-making. CONTEXT: The University of British Columbia has a history of initiatives designed to bring patient and community voices into health professional education. Increasing opportunities for interprofessional education has become important because of accreditation requirements. INNOVATION: We describe preliminary findings from a 3-year pilot of an interprofessional Health Mentors programme, an elective patient-as-teacher initiative in which groups of four students from different disciplines learn together, with and from a mentor with a chronic condition (an 'expert by experience') over three semesters. The goals, achieved through six themed meetings and a symposium, are to learn about living with a chronic condition from the patient's perspective and to develop interprofessional competencies. Groups are given suggested topics for each meeting, but function as self-managed learning communities, and are encouraged to explore their own questions. Faculty members support direct learning between students and mentors through setting broad objectives and responding to the student reflections written after each group meeting. Students and mentors rate the programme highly, and a wide range of important learning outcomes have been documented. Medical education must increase the emphasis on chronic illness care, working in partnership with patients IMPLICATIONS: Key characteristics, generalisable to other educational programmes, include the role of faculty staff in supporting learning between students and patients, a minimalist structure to promote ownership and creativity, and flexible delivery.

Patients as educators: interprofessional learning for patient-centred care.

BACKGROUND: Patients with chronic conditions have unique expertise that enhances interprofessional education. Although their active involvement in education is increasing, patients have minimal roles in key educational tasks. A model that brings patients and students together for patient-centred learning, with faculty playing a supportive role, has been described in theory but not yet implemented. AIMS: To identify issues involved in creating an educational intervention designed and delivered by patients and document outcomes. METHOD: An advisory group of community members, students and faculty guided development of the intervention (interprofessional workshops). Community educators (CEs) were recruited through community organizations with a healthcare mandate. Workshops were planned by teams of key stakeholders, delivered by CEs, and evaluated by post-workshop student questionnaires. RESULTS: Workshops were delivered by CEs with epilepsy, arthritis, HIV/AIDS and two groups with mental health problems. Roles and responsibilities of planning team members that facilitated control by CEs were identified. Ten workshops attended by 142 students from 15 different disciplines were all highly rated. Workshop objectives defined by CEs and student learning both closely matched dimensions of patient-centredness. CONCLUSIONS: Our work demonstrates feasibility and impact of an educational intervention led by patient educators facilitated but not controlled by faculty.