Is there enough patient and public involvement in medical education?

As a GP my duties as a doctor include working in partnership with patients.

As a researcher I am increasingly aware and in natural agreement with the involvement of patients and members of the public in all stages of applied research. The NIHR INVOLVE team, which encourages active public involvement in NHS, public health and social care research programs, is a great example of the formal support available for this. Researchers are strongly encouraged to involve patients/public in their research as early as possible.

But why?

That answer is summarised very nicely by Dame Sally Davies, our Chief Medical Officer

“No matter how complicated the research, or how brilliant the researcher, patients and the public always offer unique, invaluable insights. Their advice when designing, implementing and evaluating research invariably makes studies more effective, more credible and often more cost efficient as well.” (Foreword in Staley, 2009)

But what about patient and public involvement in medical education?

As a medical tutor I am always keen to encourage students into direct patient engagement. Anecdotally, the students enjoy it and because there are able to contextualize their learning, it often has more impact.

Of course medical schools involve patients and public in student education already right? Well the answer should be yes. The General Medical Council, in Tomorrows Doctors (2009) suggests that patient involvement in medical education should go beyond just early and continued student encounters with patients. In their supplementary guidance for medical schools (currently under review) they state:

“Patients can contribute unique and invaluable expertise to teaching, feedback and assessment of medical students, which should be encouraged and facilitated.”

but go on to say:

“Patient and public involvement in development of curricula and assessments, governance and quality management and control is not yet as common but there is great potential for development”

The BMA also provide guidance on the role of the patients in medical education. Pointing out that one of the challenges of patient involvement is getting students to think beyond the patient as just a “disease” or an “interesting case” study. In addition to managing potential barriers such as the existing medical culture, a lack of interest in the topic, curricula pressures, service pressures, insufficient evidence of effectiveness and lack of an effective mechanism to spread good practice.

Nevertheless, the BMA explicitly make recommendations that patients should be involved with the development and implementation of medical circular. They should be involved as teachers and assessors for many reasons.

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There are plenty more empirical examples of patients active involvement in developing medical education, many summarised in the report “Can patients be teachers? Involving patients and service users in healthcare professionals’ education” from The Health Foundation.

Patient and public involvement in medical education has also been discussed in Parliament.

With all this in mind, it was very encouraging to read of the new medical teaching Centre opened recently at the University of Manchester. The Doubleday Centre for Patient Experience was named thanks to a donation from the Dr Edwin Doubleday Fund. Edwin Doubleday, a clinical student of the university sadly died before his finals, thus never able to fulfil his ambition of becoming a doctor. Although, in an unprecedented gesture, conferred his Clinical and Surgical Degrees posthumously.

The fund was set up to promote the development of medical training and last year announced the Centre to support the development of patients and members of the public as ‘Medical Education Partners’, getting involved in aspects of medical education from the earliest stage, from interviewing potential candidates to developing course material and providing tutor feedback. The Centre was officially opened by Sir Bruce Keogh who delivered The annual Doubleday lecture, which has been nicely made into a Storify here.

Involving patients and members of the public in medical education should not be a new thing. Plenty of guidance already exists as well as examples of it occurring. However, given the benefits to future doctors, current tutors and the patients themselves, the new initiative from the University of Manchester, and in particular the idea of a network of medical education partners, is one that many more medical schools might consider.

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