Pharmacy and medicines are constantly changing, impacting on patients’ lives[1–3]. In recent years, there has been a consistent message for pharmacists to provide person-centred care, but this is not always happening in practice.
Studies looking at medicines use reviews (MURs) have highlighted concerns about the involvement of patients in consultations with pharmacists in the UK. Other studies looking at recordings of pharmacist consultations have shown they are often medicine or disease focused, rather than being person-centred.
More widely, a review published by the Department of Health and Social Care in September 2021 found fundamental problems with the underlying culture of prescribing. For example, its review of current services identified clinicians sending subliminal messages to patients that discouraged them from asking questions, such as focusing on their computer keyboard or not addressing discharge letters to the patient, instead sending them to another clinician.
This review went on to highlight the need to develop a culture of openness to challenge and welcome discussion, where this is not seen as a criticism of the prescriber, but as a way to improve prescribing.
These problems pose challenges for pharmacy education. Most would accept that it is important that pharmacy education supports the development of knowledge, skills and behaviours to provide care that is truly person-centred[7,8].
Patients could be part of the solution to these educational challenges by using their expertise to improve the healthcare system that they depend on, yet there is a lack of evidence about the prevalence of patient involvement in pharmacy education compared to medical and nursing education.
Variability in the extent of patient involvement in pharmacy education was also reflected in feedback received from a face-to-face event on ‘Patients as Partners: Collaboration to enhance practice’, led by the Royal Pharmaceutical Society (RPS) and ourselves in November 2019, which showcased patient involvement through real-life patient and pharmacist experiences. The event highlighted several barriers between patients and pharmacists, including a breakdown in communication and trust.
Seeing an individual
Andrew Taylor, who shared his experiences of healthcare as a patient with The Pharmaceutical Journal in November 2020, expressed the frustration patients experience at being left out of the conversation, especially when the patient is the subject matter. He highlighted the importance of helping pharmacy students to realise that behind the blur of diagnosis and medication is a person who expects a certain quality of life.
One of the most important details a student can learn is that every patient is different, in terms of their cultural background, religious beliefs, ethnicity, gender or sexuality and lifestyle. Consequently, each has a unique set of needs, beliefs, opinions and preferences to consider. This is often and easily forgotten yet influences the quality of their lives.
Patients live with their conditions and the corresponding medication every day. They are the only ones who know exactly how a medicine makes them feel or how it will impact on their quality of life. This personal depth of knowledge should be recognised and respected. By asking questions and talking freely to patients on a one-to-one basis and by exploring their real-world experiences and struggles, pharmacy students gain an understanding of this expertise and can think of the whole person as individual and unique.
What good looks like
Involving patients in all aspects of pharmacy education at undergraduate and postgraduate level is something we should aim to achieve as our ‘gold standard’[8,12]. It does not simply mean including patients in one-off lectures to give a monologue of their experiences.
Patient input is essential for the curriculum to grow and adapt to new issues that arise, keeping it up to date and person-centred. The involvement of patients should be proactive and organic to complement the delivery of the curriculum. It must consider the needs of the patient and ensure that they are comfortable and confident in delivering their story. This may include face-to-face interactions, video calls or even over the phone and conference calls.
In our opinion, patients carrying out question and answer sessions, webinars and lectures with students from the safety of their homes could increase the pool of patients willing to take part, as well as increasing the diversity of learning experiences for the students. There are patients who want their voices to be heard, and to be respected as part of the team, in the development of the curriculum and in learning, teaching and assessment, just as our patient participant Andrew Taylor did when he shared his experiences.
Giving students greater opportunities throughout the curriculum to explore the diversity and range of situations that can arise in patients’ lives can prepare them for dealing with difficult emotions, such as anger and frustration. No patient is perfect and it is vital that students can handle the bad with the good.
In fact, it may be liberating for a newly registered pharmacist to know that they do not need to make all the decisions and solve all the problems themselves. Instead, they should learn to metaphorically walk alongside the patient to enable their decision-making process.
Changing the curriculum
Current General Pharmaceutical Council (GPhC) standards require organisations training future pharmacists to have a learning programme on person-centred care and collaboration; however, the requirements are not as aspirational as they could be.
For example, the standard relating to MPharm degrees merely requires that the views of patients, the public and supervisors be considered when designing and delivering them. In assessment, feedback should be sought from patients, but no other role is specified.
Curriculum design and delivery must include practical experience of working with patients, carers and other healthcare professionals. The standards specify that student pharmacists must be exposed to an appropriate breadth of patients and people in a range of environments, and this experience should be progressive, increase in complexity and take account of best practice.
Nevertheless, this is a missed opportunity for the GPhC to require organisations providing pharmacy education to fully embed the patient’s voice in the curriculum and ensure they are meeting international standards on teaching about patient-centred care . This is particularly important considering that future newly registered pharmacist will become prescribers.
Every pharmacy school should have a patient advisory group, whose expertise is valued and whose members are empowered to contribute to innovative practice in all aspects of the curriculum.
Patients’ knowledge and expertise should be woven throughout the entire curriculum, which is also advocated by Tew et al. Allowing patients to give feedback on curricula keeps the educational aim focused on the patient perspective and provides an authentic voice for our students to listen to and learn from. Teaching and assessments should allow access to patients, real-world case studies and scenarios. By planning lessons and assessments with and around a patient’s perspective, students can gain valuable insight into how it feels to be on the other side of the interaction, viewing the profession from the outside and looking in.
It is important that students get the opportunity, in a safe educational environment, to talk with patients, hear their stories of good and bad practice and be allowed to ask them the questions that no amount of theory can answer. Allowing students to question practice in this way could help shape the way they deal with patients on a professional and personal level. Having patient interaction as a core strand throughout the curriculum gives students the chance to act out communication skills either face to face, over the phone or via an internet call, whether as part of teaching or assessment.
The curriculum for the MSc/PGDip Foundation Pharmacy Practice (multi-sector) programme at the University of Bradford weaves the patient voice throughout the curriculum, starting on the induction day and on subsequent study days. Patients support teaching by sharing their unique and differing experiences of pharmacy and the wider healthcare setting. Students have the opportunity to explore complex pharmaceutical issues in an informal environment. Student evaluation from the teaching has consistently scored highly and patient feedback is positive about the discussions around the issues that are raised.
To change and adapt for the better, it is important that all voices are heard, not only from patients but from regulatory and professional bodies as well as academics and students. The latter are the ones who will deliver future services, so it is vital we listen to their feedback when considering any change in curriculum. However, the patient perspective is crucial since they will benefit from the outcome.
This view is supported by colleagues in Leeds, whose involvement with patient and public involvement and engagement experiences in research has transformed their personal and professional practice to enable their perspective to change to have the space and time to truly consider the patient’s lived experience.
For us, good is knowing that patients can share their experiences with students and shape the curriculum; that a new generation of pharmacist is heading out into the world with a patient-focused outlook, built upon authentic lived experiences and an understanding of the importance of partnership in shared decision-making.
It is time to turn up the volume of patients’ voices; we need to ask and explore what they consider to be good practice so that we can learn from this and implement changes to the education and training of pharmacists, starting as undergraduate students.
The authors have no involvement with any organisation or entity that may have a financial interest in or conflict with the subject discussed in this article
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