How can we enhance 'real-time' patient involvement in medical education? A qualitative study of patients and students

Patient contact is integral to undergraduate medical training. While political strategies emphasise the 'patient's voice' in medical education, the literature on how to enhance the active involvement of real-time patients is sparse. Increased demands for real-time patient interactions in primary care poses a challenge for educators to provide adequate opportunities for students to learn. Evidence on how students may benefit from patients' active involvement may inform the design and construction of teaching/learning encounters to optimise the educational value while maintaining positive patient experiences. This study aimed to identify how the involvement of real-time patients in medical education might be enhanced. It examined two research questions: •How does enhanced patient involvement support student learning in different areas of practice? • What can be done to enhance patients' active involvement in medical students' training to support those learning benefits?

We conducted focus groups with patients, workshops and interviews with medical students and analysed the data using codebook thematic analysis.

Patient contact helped students develop their knowledge, clinical and interpersonal skills, professional values, confidence and sense of identity. Students learn by practising the role of a doctor, observing clinicians and reflecting on their experiences. Real-time patients provided experience of diversity, real-life stories and contextual variations that promoted learning. Patients would like to perform active roles, such as shaping encounters and providing explanations, feedback and emotional support to students. While such active involvement may provide learning opportunities for students, many patients were unable to perform active roles during their previous interactions with students. Patients' active involvement may be facilitated by ensuring adequate introductions, good relationships and an explicit invitation.

The resulting model may form the basis for future research and interventions that encourage and support patients to actively participate in teaching consultations. [293 words].