“For the junior student in medicine and surgery, it is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself” (Osler 1904).
The GMC takes Osler’s statement a step further and advocates the involvement of patients and public, not only in teaching, but also in feedback, assessment, development and quality assurance of medical schools curricula.
It is felt that many patients have a wealth of knowledge about their illness and can share insights into their experience that cannot be gained through any other means. In various studies, patients have come out of these experiences with a sense of high self-esteem and of ‘repaying the system’.
In December the Moorfields Eye Hospital Directorate of Undergraduate Education organised a Patient as Teacher symposium entitled: ‘Glaucoma – a silent disease’. The aim of the symposium was to provide an insight into the impact of glaucoma on a patient’s life. I was invited to join the organising faculty and interview a patient with a diagnosis of glaucoma for the symposium. It proved invaluable.
In preparation for the symposium, I read about glaucoma, particularly paying attention to symptoms, disease progression and management. Using a variety of resources including glaucoma forums and patient blogs, I was able to get a better insight into the daily challenges glaucoma patients face. This information enabled me to formulate interview questions for the symposium. I reviewed the questions with a teaching fellow, consultant and patient to ensure that the questions were suitable and the patient was given the option to veto any questions. Meeting the patient before the symposium helped me develop a rapport with him.
I don’t know what I can teach you. I have no problem with my vision.
The symposium began with my interview with the patient. The patient talked in detail about the shock and fear of his initial diagnosis, the vast amounts of internet research he had done, about his condition and the surgery he eventually underwent, and the fact that it took him two weeks to figure out a good technique to instil his eyedrops. The interview also highlighted the fact that glaucoma is a ‘silent disease’ and the patient was diagnosed through a routine sight test at his local optician’s – something which surprised much of the audience. What also struck me was the importance of knowing a patient’s occupation and how their condition might affect their day to day life. In this case, the patient was a black cab driver.
At the end of the interview, the audience were asked to write down a word or phrase which came to mind after the patient interview – I collated these and created a ‘word cloud’, which I presented at the end of the symposium. Key statements featured in this were “asymptomatic” and “teach drop technique”.
The interview was followed by a series of lectures on what glaucoma is, medical and surgical treatment, driving with glaucoma and latest glaucoma research.
During an interactive break medical students were given the opportunity to try and instil eyedrops in their own eyes, experience what it was like to have a visual field defect (using simulation spectacles) and a quiz based on the lectures we had heard, to re-enforce our learning.
Participants also had the chance to compete in a reflective essay prize. Below is a reflection from one of the essay winners: “The difficulties associated with eye drops are further compounded by the physical challenge of administering the drops, which I got to experience first-hand during the break. I ended up with as many drops on my eyelid as in my eye! It was interesting hearing how through trial-and-error, Mr. X discovered the best way to ensure the drops went into his eye, with his head tilted backwards at a 90° angle. However, I can easily imagine some patients finding the drops too difficult to use and then not bothering to use them at all. Something as simple as teaching patients an effective eye drop technique and ways to remember to use them can make a huge difference to their treatment adherence.”
The student feedback from the symposium was very positive.. A quote from one of the students sums up the general feeling: “Most of our knowledge comes from books. It’s a great opportunity to gain insight into a real patient’s experience”.
This symposium is the third of its type that has been put on by the Moorfields Eye Hospital Directorate of Undergraduate Education. The previous symposia were on age related macular degeneration and thyroid eye disease. Two forthcoming symposia in May and June this year will be on cataract and diabetic retinopathy.
The Patient as Teacher symposium was a powerful learning experience for me and in many ways has taught me things which I will never forget. In particular, the importance of understanding what a patient’s life is like when they are away from clinical setting. I will endeavor to better understand what might make a patient better able to self-manage their condition, as their time with the doctor is only a drop in the ocean.
Greg Fong, UCL Medical student
Alastair Porteous, Teaching Fellow, Moorfields Eye Hospital
Khadijah Basheer, Teaching Fellow, Moorfields Eye Hospital
Andrew Davies, teaching fellow, Moorfields Eye Hospital
Maaret Virtanen, Education Co-ordinator, Moorfields Eye Hospital
Narciss Okhravi, Director of Undergraduate Education, Moorfields Eye Hospital
Rashmi Mathew, Consultant Ophthalmologist, Moorfields Eye Hospital