"Like stepping into the patient’s shoes"

For this blog I spoke with Dr Rini Paul, a London GP and teacher development lead for King's Undergraduate Medical Education in the Community (KUMEC).

I asked Rini about her recent experience using Care Opinion in medical education.

What was the teaching challenge?

We were running a scholarly project module on patient stories, for a small number of year three students. These students haven’t had very much clinical exposure yet. They’ve had lots of time in lectures, learning the foundations of medical sciences.

So the challenge, and also the hope, was that they would engage with patient narratives in an interesting way, and think about how we can learn from patients even when we are not sitting directly opposite them, asking questions.

Why did you think Care Opinion might be a good fit for this?

The project was about online narratives. We looked at the stories on Care Opinion. There’s a huge variety and some of the stories are actually quite upsetting. However the person isn’t sitting in front of you, there’s a bit of a distance but their voice can still feel very powerful.

For students, in some ways it might be easier to engage with a written narrative because you don’t have to worry about “what shall I ask next?” or “if they say X, how should I respond?”

Although students get taught about patient-centeredness, reading these stories feels much more like stepping into the patient’s or relative’s shoes, and this is quite a safe way to do it.

How did the students respond?

The whole project was far more powerful than I could really have imagined, because I had always felt that speaking directly to patients is the absolutely best way to learn. We discovered that this is also a really powerful way to hear what patients are trying to tell us, if we would only listen.

Some students found stories that were very pertinent to their own lives. For example, one student wanted to explore narratives from patients with rheumatoid arthritis, about how the impact isn’t just about joint pain. A family member has RA, and she recognises it has an impact on her mental health and wellbeing generally. She felt strongly that the clinicians weren’t asking her mum about these other symptoms. So hearing other people’s stories about this was validating for her.

Did Care Opinion work well in practice?

The students really liked hearing about and working with Care Opinion. People in healthcare are still very wary of honest online feedback, so it was really important for them to hear about what Care Opinion does and why it was created. It’s a very simple (user-friendly) site so they found it easy to navigate and they didn’t need more guidance. They found the stories they needed.

The value for each student’s project really depended on their topic and method. For narrative analysis you need quite a long story. Lots of the Care Opinion posts don’t really fit that brief – they tend to be shorter stories. It also depends on the topic: one student had a very specific topic in mind where there would not be many stories.

Being able to search the site by story length might be helpful for some projects. Because narrative analysis often works better with a slightly longer narrative, we might trial that next time. We will definitely run this project again: the students all got into it, they really understood the purpose.

What could we do next?

This was a scholarly project with a very small number of students. In an ideal world, all 400+ of our Stage 2 (Year 2 and 3) students would have a Care Opinion login and hear patient voices in a very different way, complementing what they are seeing in clinical practice.

I know you are making plans for a “Care Opinion learning app”, with a story every day. I think students could get great value from this, especially if it is linked to the placement they are doing. A story a day related to general practice, during their general practice period – that could work really well.