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.

This post is written by Sophie Park (Professor of Primary Care and Medical Education)  and Dr Emily Owen (Research Assistant, Community Pharmacy and General Practice) 

The Society of Academic Primary Care (SAPC) in its 50th year, have collaborated with the Association for the Study of Medical Education (ASME) to host a joint conference event. Our SAPC Education Research Special Interest Group (SIG) met on Tuesday 5th July 2022 to discuss spaces for practitioner-informed research and enquiry.

It is sometimes hard to know where to start. You are a practitioner and have an area of keen interest, but feel the topic is so vast, any firm plans about research feel beyond reach. At the SIG, a group of scientists and practitioner ‘insider researchers’ met to discuss ways of beginning to bring a research idea into focus.

Stakeholder & Patient and Public involvement (PPI)

As practitioners, we often hold a view or perspective which relates to our own embodied experience and meaning-making processes about particular events. Reaching out at the outset of the project is crucial. Attentive listening to how others experience an issue is important, to help understand what others feel the key and important problems are. Continuing these conversations then enables a dynamic movement between inductive (emergent) response to generated data and deductive (pre-determined) focus on the data, embracing a range of views and concerns.

Once you start to have conversations, consider how PPI/stakeholder perspectives might shape how you approach the literature and data about this topic. How might this focus your project and analysis? We shared an on-going review (PROSPERO: CRD42022314280) exploring collaborative and integrated working between General Practice and Community Pharmacies. Having conversations with PPI/stakeholders is informing possible ways of thinking about patient care (access, help-seeking behaviour, psychological safety, continuity); working with and across multi-disciplinary colleagues; and professional development and education. These conversations support an explicit and reflexive movement between experiential priorities and the existing evidence data, helping to prioritise ways of drawing together analytical categories.

Rather than feeling anxious about the impact of your own and others’ experience on the production of data, celebrate your growing insights and understandings about these experiences, and be reflexive about how they are shaping your views during the production of the research protocol, project, and analysis. You will not be able to incorporate all PPI/stakeholder views and agendas, so establish clear expectations about the purpose of your conversations. Enjoy the contrast of views and note how these differences emerge. Might this provide you a new avenue to explore your topic?

Theory

We tend to think that whatever view we hold is ‘normal’. It is helpful, therefore, to share and discuss your ideas with others. These discussions will make visible areas of ‘cognitive dissonance’ or tensions and help to build insight about the particular theories or evidence-base you are using. Start to consider contrasting perspectives. How do these differ from yours? Is your view still helpful to hold, or might you begin to transition to a different position in your approach? This curiosity and movement between different ‘ways of knowing’ are the basis of ‘critical thinking’. These help to cultivate an appetite to understand other positions, supporting you to build a rationale for why you are approaching your research in a particular way, and how you plan to produce particular forms of knowledge outputs or artefacts.

Methods

Some approaches to research will feel more comfortable than others. Be brave and consider multiple options before you plan your project. Consider what it is you want to know, then how a different approach might enable you to know about this topic in a different way. How might each contribute to your overall aims about contribution to practice and policymaking, and moving your disciplinary knowledge field forwards? For example, do you want to create an evaluation project? These often aim to measure the effectiveness of an ‘intervention’, then perhaps make comparative claims. Instead, you might want to conceptualise it as a process, making visible the nature of that process through more exploratory or in-depth qualitative methodologies.

There is no ‘right answer’, and each project/approach will contribute in different and particular ways. What is important, is that you consider these aspects in advance, so that you can plan and anticipate the challenges and opportunities of each theoretical and practical approach from the outset.

Be Realistic

At the beginning, it can feel completely over-whelming. The planning process can feel endless: you want to move onto the practical ‘doing’ of the project as soon as possible. Be patient. Use your enthusiasm to move through the processes above: engagement and dialogue with stakeholders/PPI; reading, and re-reading literature to identify your gap; and mapping the available methods and potential knowledge outputs. Second, keep the project feasible. A focused project will enable you to progress to the next project. Ask yourself what is most important to you at this moment in time and start from there.

Peer Support

Lastly, utilise peer support during your research planning. Enjoy the creative production of your project and share your challenges. Colleagues may have experienced something similar or be able to highlight where you are identifying something innovative in your area of expertise. Through presenting your ideas to an audience, you can shift your thinking about a project: having been immersed in a particular topic, it is sometimes helpful to realise which areas are new or interesting to others. These conversations can also help you to focus your dissemination and spaces for impacting future research, practice, and policy.

Thank you to all who attended the SIG, we look forward to meeting again soon.