Why patients should be part of medical training from day one

The Reflection article by Bravery1 reminded us of the disability rights movement slogan “Nothing about us without us” and prompted us to reflect on the ways in which expert patients, carers, health and patient advocates, and community members contribute to medical student teaching at the School of Medicine at the University of Notre Dame Australia, Fremantle. Their partnership is crucial to the School being able to meet the standards — (2.1.4) “the medical education provider relates its teaching, service and research activities to the health care needs of the communities it serves,” and (4.6) “learning and teaching methods in the clinical environment promote the concepts of patient centred care and collaborative engagement” — of the Australian Medical Council’s Standards for Assessment and Accreditation of Primary Medical Programs.2

From the School’s inception in 2005, academic staff and community members have worked collaboratively, in the spirit of reciprocity, to teach students. First-year students engage with teenage mothers, expert patients and their families, older people in community-based physical activity classes, and patients in general practice settings, and they live with a family in the Wheatbelt region in Western Australia to learn first-hand about the social determinants of health and the health needs and priorities of Australians in rural settings — a program undertaken in collaboration with the medical students from Curtin University.3 By the end of the pre-clinical years, students have been taught by sex workers, people of diverse sexualities, and children with cancer via panel discussions and in clinical skills sessions, and they have shadowed a patient to witness their lived journey in a community radiology clinic. A one-week Kimberley placement provides insight into health issues in remote areas by living and working in community settings such as Indigenous communities, pastoral stations, art galleries and sporting organisations. These opportunities pave the way for collaboration between the School and other professions and industries — two-way interprofessional learning in real-world settings.

As stated by Bravery,1 the impact on students is palpable. They appreciate the opportunity to understand people’s personal perspectives4,5 and apply this understanding to their medical practice — “the [rural or remote placement] guides my work now … It comes back to me; it helps me understand rural people’s lives”.6