Learning from patients: students' perceptions of patient-instructors.

OBJECTIVES Prior research on the use of patients as teachers has focused on testing the effectiveness of this practice and exploring its benefits for students. However, very little is known about the added value of patient teaching and how it relates to patient-centred learning. The aim of this study was to explore whether there is added value in using patients as instructors in health professions education and, if there is, to examine how it is constituted. METHODS Group interviews were conducted with physiotherapy and occupational therapy students who had attended a 3-hour optional class entitled 'Thoughtful joint examination and respectful patient contact'. This class was delivered by patient-instructors (PIs), who were patients with rheumatism certified to teach. A semi-structured interview guide was used. Interviews continued until data saturation occurred (seven interviews). The interviews were recorded and transcribed verbatim. Data were analysed using content analysis. RESULTS The main finding of this study is that PI sessions facilitate a learning environment in which the content matter is complemented by the provision of realism and individual perspectives on rheumatism, the pedagogical format is characterised by authenticity and intimacy in the style of instruction and feedback, and the PI-student relationship is characterised by balanced teacher-student power relations that support the legitimacy of learning and make space for the asking of questions and the making of mistakes. CONCLUSIONS This study indicates that, in terms of power relations, the PI-student relationship differs from those between faculty teachers and students, and students and patients in the clinic. The formation of a professional identity by students may clash with the fulfilment of their learning tasks in the clinical environment. The study indicates that patient-centredness can be fostered in the PI-student relationship. This is probably supported by the absence of faculty staff involvement in PI teaching sessions. However, further empirical research is required on what, how and why students learn from patients in different learning contexts.