bridging the gap: learning with patient teachers in health professional education

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Pract. Dev. Health Care 5(1) 26–29, 2006Copyright © 2006 John Wiley & Sons, Ltd DOI: 10.1002/pdh

Research and review

Bridging the gap: Learning with patient teachers in health professional education

Fiona O’Neill—Programme Associate, Centre for the Development of Health Care Policy and Practice, University of Leeds

Penny Morris—Senior Lecturer in Communication Skills, Medical Education Unit, University of Leeds

Jools Symons—Patients as Teachers, University of Leeds

Abstract

This paper explores the value and contribution of patient voices in health professional educa-tion. The important changes in policy and practice that are slowly transforming the way that services are provided and experienced by people who have a long-term condition challenges traditional approaches to health professional education. The authors describe their philosophy and approach that supports health professionals to learn from patient voices. The value of the approach extends beyond the insights and support for learners but also has an impact on the individuals who contribute their expertise and knowledge as part of the Patients as Teachers team. Valuing and supporting members of the local community to get involved in professional education is one way of opening up the ‘ivory tower’ and challenges assumptions about who are the teachers and who are the learners. Copyright © 2006 John Wiley & Sons, Ltd.

Key words: patients as teachers, long-term conditions, health professional education

Education has a central role to play if people with long-term conditions are really going to benefit from the current raft of changes in health care policy and practice. A focus on the personal needs and expectations of individuals and how they manage their dis-ease and live their lives, often with minimal intervention from health professionals, has helped to challenge dominant views that patients are passive and in some way

Practice Development in Health CarePract. Dev. Health Care 5(1) 26–29, 2006Published online in Wiley InterScience(www.interscience.wiley.com) DOI: 10.1002/pdh.48

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A focus on the personal needs and expectations of individuals and how they manage their disease and live their lives, often with minimal intervention from health professionals, has helped to challenge dominant views that patients are passive and in some way lacking in knowledge and expertise.

lacking in knowledge and expertise. As one community leader (Jackie Reed, Chief Executive, Westside Health Authority, Chicago*) who has influenced and supported our work argues, ‘There is no such thing as humans being experts on other human be-ings – let’s get over ourselves and talk honestly and openly in response to each other’. Such insights have shaped our understanding and learning about the scale and nature of the changes required in the way health professionals are educated. At the same time the policy emphasis on involving patients and the public in health professional educa-tion has also helped to open doors, and there are new opportunities to develop innova-tive ways of embedding the patient voice in professional education.

*personal communication. (Westside Health Authority: http://www.healthauthority.org)1 The first International Conference ‘Where is the Patient Voice in Health Professional Education’ was held in Vancouver in November see http://www.health-disciplines.ubc.ca/DHCC.

Moving from a situation where patients were occasional and largely passive visitors to the classroom to a culture that values and actively supports new approaches to involving the local community, including people who have a long-term illness, in all aspects of learning and teaching is challenging. People who live with or care for someone with a long-term illness offer a very different type of expertise and knowledge that is rooted in their own experiences, not only of managing their disease, but also of navigating their journey through the health and social care system and living in a society where discrimination and inequality are still deeply embedded. While professional colleagues often voice a view that there is no need to go to the trouble of involving ‘real’ patients as ‘we are all patients aren’t we?’ this is really missing the point. Yes, professionals can draw on their own experiences as patients and or carers to enhance their teaching, but the knowledge and insights held by people who have more than a passing acquaintance with ill health and importantly are not constrained and influenced by professional value systems, is invaluable to students and teachers alike. Patient voices bring diversity into the teaching team and model the principle that patients and professionals need to ap-preciate each other’s different but equally valuable expertise in order to build relation-ships and learn together.

These are exciting times and there is growing evidence of practice sharing learn-ing and understanding of how to build meaningful and ethical ways of putting the patient voice at the centre of professional education.1 Based on our learning and insights over a number of years of development the following points need to be considered.

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First, the pace of change needs to be much faster if professionals are to be properly equipped to practice in active partnership with patients. As one patient teacher pithily remarked about the pace of change in universities, there are currently two speeds, ‘glacial and slow’. Certainly the evidence points to the need for significant change. In its recent report, Preparing the Workforce for the 21st Century, the World Health Organisation (2005) makes a case for expanding the skills of all health profes-sionals to meet the new complexities and challenges of long-term conditions and un-derlines the role that education and training has to play. Education providers need to tap into this policy agenda and use the growing body of evidence that highlights the shortfalls of traditional educational approaches in order to increase the sense of urgency and galvanize action.

The second point is more theoretical and relates to ideas about learning. The influential Brazilian educator Paulo Freire (1985) has much to teach us about educa-tional approaches that engage learners and teachers in active and equal relationships in which both sides learn from each other. Rather than an information giving ‘banking’ approach to education, that treats learners as empty bank accounts into which profes-sional educators deposit knowledge, Freire (1985) argues that real learning only occurs through empowerment of the learner through a process of dialogue with teachers and other learners based on mutual respect. Our experience confirms the value of avoiding the pitfalls of banking models. By using experiential learning and other approaches based on active engagement between teachers and learners, including appreciative en-quiry and critical reflection, students are able to work on real issues and the patient teachers are able to enter into a supportive dialogue that helps students to develop in-sights that have the potential to transform their practice. At the same time the patient teachers are also learning and develop understanding and confidence in their relation-ships with professionals outside the classroom. Importantly the experience of being re-spected and valued as part of the teaching team has helped the journey of the individu-als involved. This is particularly important for people who may have encountered problems finding suitable and rewarding work as a result of a long-term illness.

The importance of recognizing and valuing the unique contribution that pa-tient teachers bring to professional education is the third point. Education providers are now under pressure to demonstrate that they are involving service users in all as-pects of learning and teaching. But there is a real danger that involvement is seen as a ‘tick box’ requirement and the quite radical changes required to support really mean-ingful learning, that supports the patient teachers as well as students and staff, do not happen. People who have been invited to participate in teaching and development ac-tivities have important feedback to give, such as how it felt to be a lone patient voice on a 20 strong curriculum planning committee, of not being offered payment for time and expertise, and a basic lack of equipment and support. Education providers need to start by respecting the contribution that patient teachers bring and then find ways of involving individuals in a way that will nourish and develop that unique contribution.

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All this sits very comfortably with wider aspirations for higher education providers to be part of their local community, rather than in a remote and distant ‘ivory tower’. In-volving people from our diverse and vibrant local community in professional education is a really powerful way of throwing open the doors of the academy and challenging outdated assumptions about who are the teachers and who are the learners. The im-portance and value of providing really good opportunities for patients, health profes-sionals and educators to support and learn from each other continues to drive our efforts to embed the patient voice at the centre of professional education. We will continue to lobby for the resources and other sources of support required to sustain this important change within our own university. We are keen to share our learning and learn from others who may be doing similar work both in education and practice settings.

ReferencesWorld Health Organisation (2005). Preparing the Workforce for the 21st Century. Geneva: World Health

Organisation.Freire P (1985). Pedagogy of the Oppressed. Harmondsworth: Penguin Books.

Address correspondence to Fiona O’Neill, Centre for the Development of Health Care Policy and Practice, School of Health Care, Baines Wing, University of Leeds, LS2 9UT. E-mail: F.H.O’[email protected]

Involving people from our diverse and vibrant local community in professional education is a really powerful way of throwing open the doors of the academy and challenging outdated assumptions about who are the teachers and who are the learners.

bridging the gap: learning with patient teachers in health professional education

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