The time for patient partnership in medical education has arrived: Critical reflection through autoethnography from a physician turned patient.

PURPOSE: This paper explores experiences of a physician who in one life-altering day awoke in intensive care and had to embark on a complex journey as full-time patient. It identifies the important literature, albeit limited, from a unique dual lens view of physician turned patient, and analyzes the potential for advancing medical education by recognizing the expertise that patients possess from lived experience. METHODOLOGY: An autoethnography study was undertaken to unpack data obtained from lived patient experience during a two-and-a-half-year long hospitalization. Themes were captured in a series of eleven scenarios. Findings included critical reflection from the patient, medical educator, and research perspectives. Data was cross-referenced with relevant literature. RESULTS: Seven themes emerged upon critical analysis of the eleven scenarios that described real-life healthcare encounters of the physician turned patient. These often-neglected themes from medical education include experiential learning, reflection, what counts as medical care, vulnerability, patient-centred care, agency, and patient expertise. CONCLUSIONS: This study highlights differences between intellectual-experiential knowledge, and challenges medical education to harness the expertise that patients possess. It contributes to scholarly discourses by demonstrating the utility of autoethnography in medical education, critiques traditional medical education models, expands the breadth of what constitutes knowledge, and invites medical educators to actively involve patients as equal stakeholders in curricula.

Facilitating and supporting the engagement of patients, families and caregivers in research: the "Ottawa model" for patient engagement in research.

BACKGROUND: Patient engagement is increasingly being recognized as a critical component of health research; however, institutional models for building infrastructure and capacity for patient engagement in research are limited. There is an opportunity to create reproducible and scalable models of patient engagement in research and share best and promising practices. MAIN BODY: In this article, we describe the development and features of the framework for the Ottawa Patient Engagement in Research Model at The Ottawa Hospital (TOH) and the Ottawa Hospital Research Institute (OHRI). Key components of the model include: a Patient and Family Engagement Program at TOH, which recruits, educates, and supports patients, families and caregivers to engage in clinical care, governance, and research; the Ottawa Methods Centre within the OHRI, which leads methodological research and provides support to investigators for patient engagement and patient-oriented research at TOH; and the Office of Patient Engagement in Research Activities, also within the OHRI, which facilitates collaborations between patients, researchers, clinicians and other stakeholders. Early success of this model can be attributed to aligned institutional priorities between TOH, OHRI and patients, the establishment of a patient engagement policy, ongoing education and support provided to patient partners and researchers, and innovative recruitment, tracking and evaluation procedures. Ongoing challenges and next steps include promoting diversity among patient partners, implementing an equitable compensation policy, engaging patients across a variety of roles and research areas, and developing resources to expand and sustain this program. CONCLUSION: This model represents a unique effort of patients, clinicians, researchers, and policymakers across disciplines and institutions to produce a harmonized strategy and infrastructure for meaningful collaboration with patients and families in health research, and capacity building in patient-oriented research.

Involving patients and families as partners in planning, conducting, and sharing results of health research, referred to as patient engagement, is becoming more common and recognized as important part of the research process. However, guidelines and examples of how to do this well are limited. In this article, we describe the development and features of the Ottawa Patient Engagement in Research Model at The Ottawa Hospital (TOH) and the Ottawa Hospital Research Institute (OHRI). Key pieces of the model include: a Patient and Family Engagement Program, which recruits, educates, and supports patients and families to engage in clinical care, decision making, and research; the Ottawa Methods Centre, which leads studies to understand the best methods to conduct research, and provides support to researchers for patient engagement; and the Office of Patient Engagement in Research Activities, which connects patients, researchers, clinicians, and other stakeholders. Early success of this model may be a result of shared priorities between TOH, OHRI and patients, the creation of a patient engagement policy, ongoing support provided to patients, family members and researchers, and creative methods for recruitment, tracking and evaluation procedures. Ongoing challenges and next steps include promoting diversity among patient partners, setting up a fair and transparent policy for compensating patient partners, and engaging patients across a variety of roles and research areas.This model represents a unique effort of patients, clinicians, researchers, and policymakers across disciplines and institutions to produce one strategy for meaningful teamwork with patients and families in health research.

PATIENT: A Tool to Assist in Creating a Patient-Centered Team Approach to Health-Care Delivery: Lessons From a Physician Patient.

Working as a physician, I believed that health care was patient focused and that patients were active participants in their own care. A few years ago, I started a lengthy and complex journey of my own as a patient, whereby I was awakened to the fact that the health-care system does not value the patient voice nor are they included in their care. I found myself having a unique perspective, whereby I understood health-care delivery from my work as a physician; but I also understood now the patient's perspective in great detail. I know that the patient's voice is an invaluable asset in health care. Knowing what I now know, I have begun giving presentations about the patient experience to health-care professionals. I developed the acronym 'PATIENT,' to educate health-care professionals with the necessary tools to help evolve health-care delivery to the patient-centered team approach.

Determining Patient Readiness to Share Their Healthcare Stories: A Tool for Prospective Patient Storytellers to Determine Their Readiness to Discuss Their Healthcare Experiences.

Patient stories can serve as educational tools for healthcare providers. Inherent risks to the patients sharing their medical stories do exist. Despite the positive impact that patient storytelling can have in healthcare delivery, it is important to ensure the safety of those patients who chose to share their medical experiences. A novel questionnaire was developed by a diverse group of healthcare and patient partner experts. This questionnaire would serve as a self-reflective tool that prospective storytellers would complete in order to assess their readiness to proceed with storytelling as an educational tool. This draft questionnaire was then distributed to the 10 prospective patient storytellers registered to complete our pilot workshop on preparing the patient stories where they were asked to provide feedback. Overall, feedback was positive, and minor alterations were made to the questionnaire, resulting in the novel creation of this readiness assessment tool.

Learning Anatomy: Can Dissection and Peer-Mediated Teaching Offer Added Benefits over Prosection Alone?

Purpose. To evaluate the impact of an optional thoracic dissection elective upon anatomy subject acquisition and determine whether peer-mediated teaching has a beneficial effect. Methodology. First year medical students' results on thoracic anatomy laboratory examinations over a five-year period were obtained. All students were taught in the laboratory using prosected specimens as part of a standard curriculum. A subset of students from each class volunteered to participate in an optional thoracic dissection. A comparison of exam performance between the two groups was made, and the results were analyzed to see if incorporating peer teaching into the elective had an impact on the students' performance on anatomy examinations. Results. With the exception of one year's results, no significant statistical difference was found in student performance on anatomy examinations between the two groups. The addition of peer teaching did not result in superior performance. Conclusion. It is believed that prosected specimens are suitable for anatomy laboratory teaching in an undergraduate medical curriculum. Our study did not reveal that an opportunity for dissection offered any added benefit in terms of exam performance. In addition, peer teaching did not affect exam performance. This study strictly compared student exam results. It did not assess the possible impact of the dissection process to influence student attitudes towards death or the development of clinically relevant visuospatial abilities and procedural skills.

Pilot evaluation of a multidisciplinary, medically supervised, nonsurgical weight loss program on the severity of low back pain in obese adults.

BACKGROUND CONTEXT: Low back pain (LBP) is a prevalent and costly condition. Although its etiology is largely unknown, a link to obesity is suspected, and weight loss programs are often recommended to obese patients with LBP. PURPOSE: To assess the efficacy of a pilot, multidisciplinary, medically supervised, nonsurgical weight loss program involving meal replacement, caloric restriction, education, exercise, and group therapy at reducing the severity of LBP in obese adults. STUDY DESIGN: Pilot prospective cohort study. PATIENT SAMPLE: A total of 46 obese adults (mean body mass index [BMI] 44.7±7.6 kg/m2) referred to an academic hospital for a multidisciplinary, medically supervised, nonsurgical weight loss program who reported LBP were enrolled. OUTCOME MEASURES: The severity of LBP was measured using the Numerical Pain Scale (NPS) and modified Oswestry Disability Index (ODI) at baseline (Week 1), Week 14, and Week 53; weight, BMI, dietary adherence, and physical activity levels were also measured. METHODS: The 52-week weight loss program was administered by a team of physicians, dietitians, exercise specialists, and nurses and included liquid meal replacements for 12 weeks, followed by supervised caloric restriction diets for 13 weeks. Participants also attended weekly group therapy and educational meetings for the first 26 weeks, after which they were instructed to continue caloric restriction diets, engage in 60 to 90 minutes of daily physical activity, and attend monthly group meetings for an additional 26 weeks. RESULTS: At baseline, NPS was mild in 61% (n=28), moderate in 30% (n=14), and severe in 9% (n=4), whereas ODI was moderate in 48% (n=22), severe in 17% (n=8), and crippling in 4% (n=2). At Week 14 (n=42; 92% follow-up), there were significant improvements in NPS (p=.001) and ODI (p=.0005), and significant weight loss (p<.0001). At Week 53 (n=28; 61% follow-up), there was a trend toward improvement in NPS (p=.07), significant improvement in ODI (p=.0009), and significant weight loss (p=.0005); reduction in BMI was significantly associated with clinically important improvements in ODI (p=.046). CONCLUSIONS: This pilot prospective cohort study suggests that a 52-week multidisciplinary, medically supervised, nonsurgical weight loss program in obese patients with LBP improved both pain and function.