The field of neurology education has undergone significant changes alongside technological advances and a growing understanding of the science of learning and neurology (22). Since autonomic dysfunction, including AD, is associated with life-threatening complications, it is important to include this topic early in medical training and equip students with the skills to recognize it (2,3,4). Despite several reports describing the use of patients in undergraduate medical education, we found no examples of sessions involving patients living with SCI. Additionally, none of the resources we find in the literature for teaching AD involve patients who have actual experience with it (19,20,21). We developed and implemented an MTP session in which patients living with SCI shared their experiences with second-year medical students to complement the learning occurring during the course. Our goal was to promote not only knowledge, but also the humanistic and emotional aspects of medicine.
The importance of exposure to the field of neurology in medical training depends on the ability of students to develop the necessary patient-centered skills to communicate and form doctor-patient relationships with a wide range of patients (23). During our MTP session, students had numerous opportunities to interact with patients, allowing them to reinforce concepts learned, including identifying injury level, spasticity, signs and triggers of AD and loss of bowel and bladder control, while reminding them why. what they learn is important. Similar to experiential learning theories, the MTP session emphasizes learning through patient encounters early in the program, whereby the experience broadens and deepens concepts learned in class and the quiz post-session provides opportunities for deeper reflection and conceptualization (25). Additionally, the session incorporated elements of social theories of learning, focusing on social interactions, patients as individuals, and the spinal cord injury community. Knowledge acquisition was demonstrated by their performance on the post-session quiz and final exam. Our results support previous reports of improved learning outcomes associated with the incorporation of patient panels (24, 26). It is possible that by remembering patient stories, students were able to make appropriate connections and apply their knowledge to new patient scenarios during assessments. By correctly identifying life-threatening situations during exams, students could later apply these same concepts to real patients in a hospital setting. It should be noted that student engagement and knowledge acquisition may have been influenced by the incorporation of a graded quiz at the end of the session (25). Although student performance on the final exam for a question regarding the identification of Alzheimer’s disease was higher than the national average, a single question is not enough to draw a strong conclusion.
Consistent with previous reports, we found that interaction with patients was associated with high learner satisfaction (24). Most students felt that the session helped them understand the after-effects of SCI and their impact on patients. The highest level of satisfaction was with how the MTP session helped students recognize AD and its triggers. This did not surprise us since it was the central topic of the session, with more class time devoted to this topic. On the other hand, although spasticity was discussed and demonstrated in class, it might have been difficult for all students to appreciate the demonstration in the large classroom, which may explain the lower satisfaction with AD. This type of demonstration may be more meaningful if done in small groups. Since the level of student satisfaction is correlated with the focus of the session, the time spent on each topic and prepared questions can be adjusted according to the specific learning objectives and goals of the session.
To our great surprise, the level of satisfaction with the session of the second academic year was lower than that of the first year of implementation, despite the lack of change in knowledge acquisition. The major difference between the two sessions was the number of patients, session time, and student attendance (less in all cases for the less satisfied class). Some second-year students did not attend the session and yet completed the satisfaction survey. Although our study design did not account for the reasons for these differences, it is possible that some students who did not attend the session felt they needed to answer the “satisfaction” questions since they were at the end of the graded quiz; answering the “satisfaction” questions without attending the session may have altered the data. On the other hand, there could be other differences between sessions that could explain the different levels of satisfaction. For example, discussions occurred in the first year, but not in the second year, including topics related to nutrition and foods that make bowel problems worse, sex life, and orgasm as a trigger of AD, and the use of endocannabinoids for pain relief after SCI. . These discussions generated a lot of interest among the students and encouraged them to participate more; this could have allowed for a better holistic understanding of patients living with SCI and the impact of disability on daily life. Additionally, one of the patients in the first session is a strong advocate for people with SCI and had extensive public speaking experience, which could have been more impactful for the students.
Establishing a partnership between patients, faculty and students is essential to enhance the learning experiences of all participants (24, 27,28,29). For our MTP session, we made a conscious effort to ensure that our patients had a meaningful and enriching encounter with the students. As in previous reports, our patient’s primary role was that of “patient-teacher” and we deliberately attempted to establish a partnership with patients in which they felt involved and empowered (29) During session planning, patients were informed extensively about the objectives and audience, and they were empowered to suggest questions and topics for discussion. During the session, most patients felt comfortable using their experiences to participate in teaching the basics of their disease, e.g. neurogenic bladder, catheterization, mechanism of action medicine, etc. Emphasis was placed on appropriate communication language when interacting with people with disabilities. For example, patients provided resources and advice to students during the session (e.g., avoiding wheelchairs, disabled people, disabled people, etc.).
Based on our experience, we recommend that all patients be trained before the session and have at least one “rehearsal session”. Although attorneys with public speaking experience may be preferred in some contexts, other patients may be selected provided they are invested in the learning process. Patients should not only be comfortable with the format and content of the session, but they should also be empowered to suggest and make changes that they feel are important to communicate to students. Additionally, the session should incorporate opportunities that expand students’ understanding of the disease beyond concepts learned in the classroom, such as the impact of the disease on daily life. We believe it is important to provide ample opportunities for interactions between students and patients, which helps create positive connections and increase students’ comfort level when speaking with people with disabilities. These observations are consistent with previous reports in the literature (24). Although our session focused primarily on AD, the same principles can be applied to other conditions/diseases.
Our results have several limitations. We assessed only short-term knowledge acquisition, we used a small number of questions, and there was no control group to assess the effectiveness of MTP compared to other learning strategies. Even if comparing pedagogies was not our objective, we cannot exclude that other methods could be as effective in helping students acquire knowledge. Nonetheless, MTP was initially designed to complement rather than replace and may have benefits beyond knowledge transfer. This type of patient encounter may result in improved long-term retention and/or changes in behavior or practice that can transfer to patient care. This is an important question that merits further research, involving longer periods, adequate controls, and possibly more MTP sessions.
