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.

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.

Active patient involvement in the education of health professionals.

CONTEXT: Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient-centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self-care. METHODS: We reviewed and summarised the literature on active patient involvement in health professional education. RESULTS: A synthesis of the literature reveals increasing diversity in the ways in which patients are involved in education, but also the movement's weaknesses. Most initiatives are 'one-off' events and are reported as basic descriptions. There is little rigorous research or theory of practice or investigation of behavioural outcomes. The literature is scattered and uses terms (such as 'patient'!) that are contentious and confusing. CONCLUSIONS: We propose future directions for research and development, including a taxonomy to facilitate dialogue, an outline of a research strategy and reference to a comprehensive bibliography covering all health and human services.

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.

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.

Difficult incidents and tutor interventions in problem-based learning tutorials.

CONTEXT: Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. OBJECTIVES: The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. METHODS: Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. RESULTS: The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. CONCLUSIONS: Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

Shared decision-making.

Shared decision-making has been called the crux of patient-centred care and identified as a key part of change for improved quality and safety in healthcare. However, it rarely happens, is hard to do and is not taught - for many reasons. Talking with patients about options is not embedded in the attitudes or communication skills training of most healthcare professionals. Information tools such as patient decision aids, personal health records and the Internet will help to shift this state, as will policy that drives patient and public involvement in healthcare delivery and training.

Doctor-patient communications in the Aboriginal community: towards the development of educational programs.

OBJECTIVE: Aboriginal people in Canada have poorer health than the rest of the population. Reasons for health disparities are many and include problems in communication between doctor and patient. The objective of this study was to understand doctor-patient communication in Aboriginal communities in order to design educational interventions for medical students based on the needs and experiences of patients. METHODS: Experiences of good and poor communication were studied by semi-structured interviews or focus groups with 22 Aboriginal community members, 2 community health representatives and 2 Aboriginal trainee physicians. Transcribed data were coded and subjected to thematic analysis. RESULTS: Positive and negative experiences of communicating with physicians fell into three broad and interrelated themes: their histories as First Nations citizens; the extent to which the physician was trusted; time in the medical interview. CONCLUSION: Aboriginal peoples' history affects their communication with physicians; barriers may be overcome when patients feel they have a voice and the time for it to be heard. PRACTICE IMPLICATIONS: Physicians can improve communication with Aboriginal patients by learning about their history, building trust and giving time.

Enhancing the relationship and improving communication between adolescents and their health care providers: a school based intervention by medical students.

OBJECTIVE: To develop, implement and evaluate a workshop to help adolescents develop independent and active relationships with their physicians. METHODS: A needs-assessment survey informed the development of a workshop delivered by medical student volunteers and incorporated into the career and personal planning curriculum of high schools in Vancouver, Canada. RESULTS: Over a 6-year period, 64 workshops were delivered by 181 medical students to 1651 high school students in six schools. CONCLUSION: The workshop is acceptable, do-able, effective and sustainable, characteristics that arise from the mutual benefits to all the groups involved: the medical school, the school board, the medical students, the high school teachers and students. The workshop provides a model for providing health care education to adolescents in the community. PRACTICE IMPLICATIONS: Teaching adolescents the importance of good doctor-patient communication encourages them to take ongoing responsibility for their health care and is an alternative route to direct health care education.

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.

Patient perceptions that limit a community-based intervention to promote participation.

A workshop designed to teach seniors to communicate more effectively with their physicians and enhance patient participation in the consultation was held in a community centre. A grounded theory analysis of follow-up telephone interviews provided examples of effectiveness but also revealed six categories of barriers to changing the pattern of established communication, particularly over the short term.

Putting informed and shared decision making into practice.

OBJECTIVE: To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter. BACKGROUND: Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers. DESIGN: Qualitative analysis of transcripts of consultations and key informant group interviews. SETTINGS AND PARTICIPANTS: Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM. RESULTS: The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency-specific barriers. CONCLUSION: A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well-established patterns of communication with patients.