ror.org/04sjchr03
Résumés
Abstract
Background: To train physicians who will respond to patients’ evolving needs and expectations, medical schools must seek educational strategies to foster the development of non-technical competencies in students. This article aims to synthetize studies that focus on patient engagement in medical training as a promising strategy to foster the development of those competencies.
Methods: We conducted a rapid review of the literature to synthetize primary quantitative, qualitative and mixed studies (January 2000-January 2022) describing patient engagement interventions in medical education and reporting non-technical learning outcomes. Studies were extracted from Medline and ERIC. Two independent reviewers were involved in study selection and data extraction. A narrative synthesis of results was performed.
Results: Of the 3875 identified, 24 met the inclusion criteria and were retained. We found evidence of a range of non-technical educational outcomes (e. g. attitudinal changes, new knowledge and understanding). Studies also described various approaches regarding patient recruitment, preparation, and support and participation design (e.g., contact duration, learning environment, patient autonomy, and format). Some emerging practical suggestions are proposed.
Conclusion: Our results suggest that patient engagement in medical education can be a valuable means to foster a range of non-technical competencies, as well as formative and critical reflexivity. They also suggest conditions under which patient engagement practices can be more efficient in fostering non-instrumental patient roles in different educational contexts. This supports a plea for sensible and responsive interventional approaches.
Résumé
Contexte : Pour former des médecins aptes à répondre aux besoins et attentes évolutifs des patients, les facultés de médecine doivent trouver des stratégies éducatives pour stimuler le développement de compétences non techniques chez les étudiants. Cet article vise à synthétiser les études qui traitent de la participation des patients à la formation médicale comme stratégie prometteuse pour favoriser le développement de ces compétences.
Méthodes : Nous avons effectué une revue rapide de la littérature pour synthétiser les études primaires quantitatives, qualitatives et mixtes (janvier 2000-janvier 2022) qui décrivent des interventions visant l’engagement des patients dans la formation médicale et qui font état de résultats d’apprentissage non technique. Les études ont été extraites de Medline et d’ERIC. Deux examinateurs indépendants ont participé à la sélection des études et à l’extraction des données. Une synthèse narrative des résultats est présentée.
Résultats : Parmi les 3875 études recensées, 24 répondaient aux critères d’inclusion et ont été retenues. Ces études font état d’apprentissages non techniques (par exemple, des changements d’attitude, des compréhensions et connaissances nouvelles). Les études décrivent également diverses approches de recrutement et de préparation des patients, et diverses manières de concevoir leur participation (par exemple, la durée du contact, l’environnement d’apprentissage, l’autonomie du patient et le format) et le soutien pédagogique qui en découle. Quelques suggestions pratiques émergentes sont proposées.
Conclusion : D’après nos résultats, l’engagement du patient dans l’éducation médicale constitue une avenue prometteuse pour favoriser le développement d’une panoplie de compétences non techniques, tout comme la réflexivité formative et critique des étudiants. Ils indiquent également certaines conditions et contextes éducatifs qui favorisent la participation non instrumentale des patients. Il s’agit d’un plaidoyer en faveur d’interventions éducatives centrées sur les besoins et préoccupations des acteurs impliqués et sur les particularités des contextes locaux.
Parties annexes
Bibliography
- Pomey M-P, Flora L, Karazivan P, et al. Le « Montreal model » : enjeux du partenariat relationnel entre patients et professionnels de la santé. Sante Publique. 2015;S1(HS):41. https://doi.org/10.3917/spub.150.0041
- Tuckett D, Boulton M, Olson C, Williams, A. Meetings between experts: an approach to sharing ideas in medical consultations. London: Tavistock; 1985.
- Flora L, Berkesse A, Payot A, Dumez V, Karazivan P. Chapitre 3. L’application d’un modèle intégré de partenariat-patient dans la formation des professionnels de la santé : vers un nouveau paradigme humaniste et éthique de co-construction des savoirs en santé. J Int Bioethique. 2016;27(1):59. https://doi.org/10.3917/jib.271.0059
- Jha V, Quinton ND, Bekker HL, Roberts TE. Strategies and interventions for the involvement of real patients in medical education: a systematic review. Med Educ. 2009;43(1):10-20. https://doi.org/10.1111/j.1365-2923.2008.03244.x
- Towle A, Bainbridge L, Godolphin W, et al. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64-74. https://doi.org/10.1111/j.1365-2923.2009.03530.x
- Flin RH, O'Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Burlington, VT: Ashgate Publishing, Ltd.; 2008.
- Prineas S, Mosier K, Mirko C, Guicciardi S. Non-technical skills in healthcare. In: Donaldson L, Ricciardi W, Sheridan S, Tartaglia R (eds). Textbook of Patient Safety and Clinical Risk Management. Cham, CH: Springer International Publishing; 2021. p. 413-34.
- Gordon M, Baker P, Catchpole K, Darbyshire D, Schocken D. Devising a consensus definition and framework for non-technical skills in healthcare to support educational design: a modified Delphi study. Med Teach. 2015;37(6):572-577. https://doi.org/10,3109/0142159X.2014.959910
- Frenk, J, Chen L, Bhutta ZA, et al. Health professionals for a new entury: transforming education to strengthen health systems in a interdependent world. Lancet. 2010;376(9756):1923-58. https://doi.org/10.1016/S0140-6736(10)61854-5
- Holton, R. A new epoch for health professionals’ education. Lancet. 2010;376(9756):1875-7. https://doi.org/10.1016/S0140-6736(10)62008-9
- Spencer J, Balckmore D, Heard S, et al. Patient-oriented learning: a review of the role of the patient in the education of medical students. Med Educ. 2000;34(10):851-857. https://doi.org/10.1046/j.1365-2923.2000.00779.x
- Gordon M, Gupta S, Thornton D, Reid M, Mallen E, Melling A. Patient/service user involvement in medical education: a best evidence medical education (BEME) systematic review: BEME Guide No. 58. Med Teach. 2020;42(1):4-16. https://doi.org/10.1080/0142159x.2019.1652731
- Khalife R, Gupta M, Gonsalves C, et al. Patient involvement in assessment of postgraduate medical learners: a scoping review. Med Educ. 2022;56(6):602–613. https://doi.org/10.1111/medu.14726
- Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Systematic Reviews. 2012;1(1):10-. https://doi.org/10.1186/2046-4053-1-10
- Tricco AC, Langlois EV, Straus SE. Rapid reviews to strengthen health policy and systems: a practical guide. Geneva: World Health Organization; 2017.
- Barry Issenberg S, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10-28. https://doi.org/10.1080/01421590500046924
- Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach. 2007;29(8):735-51. https://doi.org/10.1080/01421590701682576
- Barr H, Koppel I, Reeves S, Hammick M, Freeth DS. Effective interprofessional education: argument, assumption and evidence (promoting partnership for health). New York: John Wiley & Sons; 2008.
- Boet S, Sharma S, Goldman J, Reeves S. Review article: medical education research: an overview of methods. Can J Anaesth. 2012;59(2):159-70. https://doi.org/10.1007/s12630-011-9635-y
- Aires MJ, Gagnayre R, Gross O, et al. The patient teacher in general practice training: perspectives of residents. J Patient Exp. 2019;6(4):287-95. https://doi.org/10.1177/2374373518803630
- Barr J, Bull R, Rooney K. Developing a patient focussed professional identity: an exploratory investigation of medical students' encounters with patient partnership in learning. Adv Health Sci Educ Theory Pract. 2015;20(2):325-38. https://doi.org/10.1007/s10459-014-9530-8
- Bideau M, Guerne PA, Bianchi MP, Huber P. Benefits of a programme taking advantage of patient-instructors to teach and assess musculoskeletal skills in medical students. Ann Rheum Dis. 2006;65(12):1626-30. https://doi.org/10.1136/ard.2004.031153
- Cumberland DM, Sawning S, Church-Nally M, Shaw MA, Branch E, LaFaver K. Experiential learning: transforming theory into practice through the Parkinson's disease buddy program. Teach Learn Med. 2019;31(4):453-65. https://doi.org/10.1080/10401334.2019.1580583
- DeSipio J, Gaughan J, Perlis S, Phadtare S. Use of real patients and patient-simulation-based methodologies for teaching gastroenterology to pre-clinical medical students. Healthcare. 2018;6(2):12. https://doi.org/10.3390/healthcare6020061
- Dickinson BL, Lackey W, Sheakley M, Miller L, Jevert S, Shattuck B. Involving a real patient in the design and implementation of case-based learning to engage learners. Adv Physiol Educ. 2018;42(1):118-22. https://doi.org/10.1152/advan.00174.2017
- Duke P, Cohen D, Novack D. Using a geriatric mentoring narrative program to improve medical student attitudes towards the elderly. Educ Gerontol. 2009;35(10):857-66. https://doi.org/10.1080/03601270902782412
- Fitzpatrick C, Musser A, Mosqueda L, Boker J, Prislin M. Student Senior Partnership Program: University of California Irvine School of Medicine. Gerontol Geriatr Educ. 2006;27(2):25-35. https://doi.org/10.1300/J021v27n02_04
- Frey J, Neeley B, Umer A, et al. Training in Neurology: Neuro Day: An Innovative Curriculum Connecting Medical Students With Patients. Neurology. 2021;96(10):e1482-e6. https://doi.org/10.1212/WNL.0000000000010859
- George DR, Stuckey HL, Dillon CF, Whitehead MM. Impact of participation in TimeSlips, a creative group-based storytelling program, on medical student attitudes toward persons with dementia: a qualitative study. Gerontologist. 2011;51(5):699-703. https://doi.org/10.1093/geront/gnr035
- Hendriksz T. Using patient perspective sessions to increase empathy and recall in preclinical medical students. J Am Osteopath Assoc. 2016;116(10):662-6. https://doi.org/10.7556/jaoa.2016.130
- Henriksen AH, Ringsted C. Medical students' learning from patient-led teaching: experiential versus biomedical knowledge. Adv Health Sci Educ Theory Pract. 2014;19(1):7-17. https://doi.org/10.1007/s10459-013-9454-8
- Hoffman KG, Gray P, Hosokawa MC, Zweig SC. Evaluating the effectiveness of a senior mentor program: the University of Missouri-Columbia School of Medicine. Gerontol Geriatr Educ. 2006;27(2):37-47. https://doi.org/10.1300/J021v27n02_05
- Jha V, Winterbottom A, Symons J, et al. Patient-led training on patient safety: a pilot study to test the feasibility and acceptability of an educational intervention. Med Teach. 2013;35(9):e1464-71. https://doi.org/10.3109/0142159X.2013.778391
- Kangasjarvi E, Ng SL, Friesen F, Simpson JS. Patients as teachers and arts-based reflection in surgical clerkship: a preliminary exploration. Med Teach. 2020;42(12):1362-8. https://doi.org/10.1080/0142159X.2020.1807482
- Owen C, Reay RE. Consumers as tutors - legitimate teachers? BMC Med Educ. 2004;4:14. https://doi.org/10.1186/1472-6920-4-14
- Player E, Gure-Klinke H, North S, et al. Humanising medicine: teaching on tri-morbidity using expert patient narratives in medical education. Educ Prim Care. 2019;30(6):368-74. https://doi.org/10.1080/14739879.2019.1670097
- Shapiro D, Tomasa L, Koff NA. Patients as teachers, medical students as filmmakers: the video slam, a pilot study. Acad Med. 2009;84(9):1235-43. https://doi.org/10.1097/ACM.0b013e3181b18896
- Stojan JN, Sun EY, Kumagai AK. Persistent influence of a narrative educational program on physician attitudes regarding patient care. Med Teach. 2018:1-8. https://doi.org/0142159X.2018.1436755
- Coe TM, Chirban AM, McBroom TJ, et al. Virtual student-transplant patient interactions empower patients and enhance student transplantation knowledge. Am J Surg. 2021;222(6):1120-5. https://doi.org/10.1016/j.amjsurg.2021.09.025
- Ivory KD, Luscombe G, Klein LA, Barratt A. "Thank you for giving me a voice!" a longitudinal evaluation of patients' experience of partnering with students in an Australian Medical School. J Med Educ Curric Dev. 2017;4:2382120517692776. https://doi.org/10.1177/2382120517692776
- Jha V, Buckley H, Gabe R, et al. Patients as teachers: a randomised controlled trial on the use of personal stories of harm to raise awareness of patient safety for doctors in training. BMJ Qual Saf. 2015;24(1):21-30. https://doi.org/10.1136/bmjqs-2014-002987
- Kumagai AK, Murphy EA, Ross PT. Diabetes stories: use of patient narratives of diabetes to teach patient-centered care. Adv Health Sci Educ Theory Pract. 2009;14(3):315-26. https://doi.org/10.1007/s10459-008-9123-5
- Harris M, Camenzind A-L, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC Med Educ. 2020;20(1):217. https://doi.org/10.1186/s12909-020-02136-y
- Patton MQ. Utilization-focused evaluation. Thousand Oaks: SAGE; 2012.
- Guba E, Lincoln Y. Fourth Generation Evaluation. Newbury Park, CA: SAGE; 1989.
- Mertens DM. Transformative research and evaluation. New York: Guilford Press; 2009.
- Tremblay M-C, Richard L, Brousselle A., Beaudet N. Learning reflexivity from a health promotion professional development program in Canada. Health Promotion International. 2014; 29(3):538-48.