Teaching medical students about chronic disease: patient-led teaching in rheumatoid arthritis

To evaluate the effectiveness of patient-led teaching compared with doctor-led teaching, regarding the impact of chronic disease (rheumatoid arthritis [RA]).

A set of learning objectives regarding the impact of RA on patient and family was designed. Students (n = 42) attached to the academy for their musculoskeletal diseases module were randomized to teaching either by a doctor or a patient. Outcome was assessed using a knowledge test, feedback forms and qualitative written interview.

In the knowledge test, the groups performed equally. The patient-taught group scored 24.5 +/- 3.5 (max 35); the doctor-taught group scored 24.6 +/- 4.1 (p > 0.05; NS). Feedback was completed by 40/42 students. Mean scores for the overall grading of teaching (1-5, where 1 = worst, 5 = best) were: patient teaching 4.36 (95% confidence interval [CI] 4.11, 4.61); doctor teaching 3.69 (95% CI 3.52, 3.92).The difference between the average scores was 0.42 (p = 0.005). Qualitative feedback showed recurring themes that students appreciated the personal nature of the patient's teaching, enabling them to understand the impact of the disease on patients and their families. The doctors' teaching was also appreciated, particularly the interactive style and opportunity to participate in role play.

We have demonstrated that our patient was at least as good as a doctor at teaching about the impact of chronic disease on patients. Furthermore, this experience is valued by students who appreciate the personal insight that a patient can offer.