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Should we involve terminally ill patients in teaching medical students? A systematic review of patient's views
  1. Dylan Gareth Harris1,
  2. Bernadette Coles2 and
  3. Hannah May Willoughby3
  1. 1Department of Palliative Care, Prince Charles Hospital, Merthyr Tydfil, UK
  2. 2Department of Information Services, Cardiff University, Velindre Hospital, Cardiff, UK
  3. 3Department of Postgraduate General Practice Education, Cardiff University School of Medicine, Cardiff, UK
  1. Correspondence to Dr Dylan Harris, Department of Palliative Care, Prince Charles Hospital, Merthyr Tydfil CF47 9DT, UK; dgharris{at}doctors.org.uk

Abstract

Objective To review available published research that has explored how terminally ill patients feel about being involved in undergraduate medical teaching.

Methods A systematic review using narrative synthesis. Qualitative or quantitative publications were included if they directly explored the views of adult patients, with a terminal diagnosis, about their involvement in undergraduate clinical teaching.

Results Seven publications met the inclusion criteria: one case report, one qualitative study and five questionnaire-based studies. A total of 269 patients were included across all studies. Patients were predominantly studied in a hospice or hospice day care setting. Both patients who had, and who had not, previously been involved in student teaching were captured by the included publications. In general, the views of patients were highly positive: overall 85%–100% were in favour of involvement in teaching. There were also some negative aspects, such as: concerns about being physically examined by a student; finding involvement in teaching tiring; feeling unable to decline consent to participate.

Conclusions An assumption that clinical undergraduate medical teaching involving terminally ill patients may be too burdensome is not reflected overall in studies that have sought the views of the patients themselves. Understanding the patient's perspective provides a number of practical points in relation to how clinical teaching should be adapted in this patient group; for example, using smaller student group sizes; direct supervision if physical examination performed; short encounters with multiple patients rather than a longer encounter with one patient; adequate informed consent beforehand and without the students automatically being present.

  • Education and training
  • Communication
  • Terminal care
  • Received 12 June 2013.
  • Revision received 18 December 2013.
  • Accepted 19 January 2014.

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  • Received 12 June 2013.
  • Revision received 18 December 2013.
  • Accepted 19 January 2014.
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