Patients and Families as Advisors: Enhancing Medical Education Curricula

ABSTRACT

Patients and Families as Advisors: Enhancing Medical Education Curricula

BACKGROUND: Patients and caregivers bring a perspective to medical education that informs the development of curriculum activities and helps build a patient-centered, family-centered approach to care among medical students.

OBJECTIVES: 1) To describe physician competencies from the perspective of patients and families. 2) To develop activities for medical school curricula that incorporate patient and family perspectives. 3) To build medical student skills and attitudes to address patient and family needs.

METHODS: We convened 12 parents of children with chronic health conditions to describe physicians who had been most helpful to them, their children and their families. The group met for four months to learn about medical school, describe physician behaviors and attitudes, group behaviors and attitudes in categories, and draft curriculum activities.

Continuing process: Over 200 patients and family members have participated in development of medical education curriculum activities and teaching over 10 years. Small groups of advisors meet to address topics and specific curricular materials. With a facilitator, they share experiences, write behavioral descriptors, draft materials and activities (e.g., standardized patient checklists and scenarios, discussion questions, small group activities). Advisors with relevant experience teach with other medical school faculty.

RESULTS: The parents described physician behaviors and attitudes in four categories: self-awareness (e.g., acknowledgement of limits, attitudes about people with disabilities), communication (with patients, families, and health professionals), shared medical decision-making, and advocacy (for individuals and in systems).

Outcomes: Early curriculum activities included a pediatric home visit with parents, children and young adults as teachers, small-group discussions about ethical decision-making, patients and parents coaching students in communication skills, and a workshop about advocating for patients and families. Advisors have participated in progressive revision of earlier activities to fit adjusted curricular goals and development of new activities (e.g, a health supervision curriculum). Current activities developed and co-taught with advisors occur in four academic departments.

CONCLUSIONS: Patients and their families emphasize physician competencies that affect patient/physician relationships, communication, and planning health care in ways that reflect an understanding of the context of patients’ lives. They can collaborate to develop and teach these competencies.

NEXT STEPS: The advisor group will provide consultation to four committees accomplishing curriculum reform. New focus groups will reconsider the original four categories of physician behavior for possible revision.

BACKGROUND

Janice L. Hanson, PhD1; Patrick O’Malley, MD1; Virginia F. Randall, MD2; William Sykora, MD2; Pamela Williams, MD2; Brian Unwin, MD2; Edmund Howe, MD, JD3; Charles Engel, MD3 and Patient- and Family-Advisors 1Department of Medicine, 2Department of Pediatrics, 3Department of Family Medicine and 4Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland

METHODS

Parent work group/focus group:

Sampling: extreme cases (12 parents of children with chronic health conditions)

Four sequential work group/focus group sessions Introduction to medical education Envision a physician who has been particularly helpful to you,

your child and/or your spouse. What did that physician do? “Member checking” of tentative themes Brainstorming session : How could we teach these behaviors to

medical students? Data analysis: qualitative analysis of behavioral descriptors

Work group process to develop new activities for medical education:

RESULTS

Themes:

Self-awareness (e.g., awareness of limits and strengths, attitudes about people with illness or disabilities)

Communication (with patients, families, and health professionals) Shared medical decision-making Advocacy (for individuals and in systems).

CONCLUSIONS

Patient- and family-advisors bring energy, commitment, creativity and an important voice identifying themes for medical education, helping to develop new curricular activities and co-teaching.

NEXT STEPS Update themes, sampling for maximum diversity. Work with curriculum re-design committees

Pre-clerkship: develop case scenarios, revise home visitClerkship: collaborate regarding communication?Post-clerkship: develop a patient-centered capstone projectAssessment: incorporate communication assessment across curriculum

Patient-advisor working group

RESULTS

A father discussing ethical challenges with second-year students

For additional information please contact:

Janice L. Hanson, PhDDepartment of MedicineUniformed Services University of the Health Sciencesjhanson@usuhs.edu

OBJECTIVES

1)To describe physician competencies from the perspective of patients and families.

2)To develop activities for medical school curricula that incorporate patient and family perspectives.

3)To build medical student skills and attitudes to address patient and family needs.

Curricular Activities:

Home visits Pediatrics Family medicine (revised family study) Introduction to Clinical Medicine I, The Medical Interview

Ethics course: small group discussions with parentsHuman behavior course: Articles, parent lecture, differential diagnosis, discussionCase-based sessions: the pediatric interview, developmental delays and intervention, anticipatory guidanceResearch projects for medical studentsWorkshop: Patient-centered healthcare planning (Family Medicine Clerkship)Standardized patient cases for assessment (Introduction to Clinical Medicine III, Family Medicine Clerkship, pilot fourth-year OSCE, anticipatory guidance case for health supervision curriculum)Health supervision curriculum (6 cases for study and discussion, Structured Clinical Evaluation)

Invited to form the Task Force on Patient and Family Communications, Curriculum Re-Design, School of Medicine, Uniformed Services University of the Health Sciences, which will help the curriculum re-design committees foster a consistent, patient-centered approach in students and facilitate the presence of the patient's voice in defining curricular elements and outcomes.

Competency Pre Post Total possible

Significance (paired t-

test)Basic communication (n=112) 6.9 7.5 8 p<.001

Building a relationship (n=123) 6.0 7.7 10 p<.001

Communicating about context (n=112) 10.6 14.6 16 p<.001

Communicating about resources (n=122) 10.3 12.7 17 p<.001

Sample evaluation data:

Program-level outcome: