Patient and Public Involvement and Engagement (PPIE) in clinical student assessment and feedback on students’ patient-centred communication skills

This post is written by Sadie Lawes-Wickwar (Lecturer in Medical Education), Sara Garfield (Lecturer in Pharmacoepidemiology and Drug Safety Practice & Policy), Margaret Ogden (Public contributor), Ishveer Sanghera (Medical Student), Cate Whittlesea  (Divisional Director UCL School of Pharmacy), Sophie Park (Professor of Primary Care and Medical Education), and Afia Ali  (Professor of Neuroscience Pharmacology).

The importance of person-centred communication

Person-centred communication demonstrates good clinical practice and is central to personalised and person-centred care as outlined in the recent NHS England ‘Person Centred Approaches’ framework. This includes verbal and non-verbal behaviours to provide clear information, involve patients in decisions, respect individual preferences, and provide emotional support and empathy. Person-centred communication skills are important for healthcare professionals and need to be gained through skills development and practice (including role play where needed) with appropriate feedback during clinical training. This feedback (whether verbal or written) could be valuable from patients, carers and the public, i.e. the recipients of person-centred care. Medical regulatory bodies, such as General Pharmaceutical Council (GPC) and General Medical Council (GMC), stipulate that patients, carers, and the wider public should be involved in clinical training, and that this should include assessment and feedback.

The role of patients and the public in clinical exams has traditionally been limited and/or passive (e.g. a “case presentation”). As student assessment is a more intensive, curriculum-led type of involvement (over, say, sharing lived experiences which is a common involvement activity in clinical education), this may require a lot of preparation for public contributors, such as training, buddying and mentoring.

Insights from our co-design workshops

There has been little formal research and recommendations for patients and carers to assess students in their person-centred communication skills. This was the rationale for a recent collaboration between the Primary Care Medical Education Expert by Experience (EbE) Group and UCL’s School of Pharmacy EbE Group. Our collaborative group was awarded a ChangeMakers grant in February 2023 to plan and deliver co-design workshops with key stakeholders. Our project aimed to develop a ‘framework’ to guide patient and public feedback for clinical students about their communication skills. We held two ‘World café’ style workshops. ‘World café‘ is a community engagement approach for discussing key ideas with large groups of stakeholders in smaller ‘round’ tables. The aim was to: (1) explore opportunities and challenges for patient and carer involvement in student feedback and assessment, and (2) create an assessment ‘framework’ that can be pilot tested in the future. The workshops were attended by students, public contributors (with lived experiences as patients and carers), and UCL academics from the Primary Care and School of Pharmacy teaching teams.

Four key areas were highlighted as being important to workshop participants in student feedback and assessment in relation to person-centred communication: (1) Information and training for public contributors and students, (2) forms of assessment, (3) suitable methods and pathways by which patients and carers could provide feedback, and (4) support and wellbeing of public contributors and students. We also heard from students that their needs differ in the earlier years (typically pre-clinical) to the later (clinical) years of their course. During the early years they would benefit from receiving patient feedback from public contributors who have had training in giving feedback. During their formal clinical training they need to obtain feedback from patients they meet on clinical placements who may not have had such training.

Participant feedback

Participant feedback from the ChangeMakers project was that the workshops enabled diverse views to be heard and these were thought provoking afternoons. However, on balance there was a lot to discuss in the time we had, and so we plan to continue exploring these issues in future Collaborative EbE Group meetings and in future research. Feedback from our public contributors was very positive. One has shared her experiences of contributing to our ChangeMakers project:

“I was keen to be involved in the Changemakers project because it spans research and education. I haven’t been disappointed. There’s been a lot of contact with students and researchers. Also many reviewing opportunities for PPIE input.  I have been able to build on my knowledge in both fields following an honorary degree of Bachelor of Education which I received from York St John University, so it has been very valuable experience”

Next steps

Our next steps are to explore training opportunities for patients and carers invited to join student assessments and clinical placements, as well as training for students to ask for and process feedback from patients. We are also planning research to formally assess acceptability and feasibility of patient and carer involvement in clinical assessments from the perspective of a variety of stakeholders (e.g. students, Medical and Pharmacy School leaders, allied health professionals, patients and carers). We are looking forward to continuing our work in this area.