The field of neurology education has experienced significant changes that parallels the advances in technology and a growing understanding of both, the science of learning and neurology [22]. Given that autonomic dysfunction, including AD, is associated with potentially life-threatening complications, it is important to include this topic early in medical education and equip students with the skills needed to recognize it [2,3,4]. Despite several reports describing the use of patients in undergraduate medical education, we did not find examples of sessions involving patients living with SCI. Moreover, none of the resources we find in the literature to teach about AD involve patients that have real-life experience with it [19,20,21]. We developed and implemented a MTP session in which patients living with SCI shared their experiences with second-year medical students to complement the learning occurring in the course. Our goal was to foster not only knowledge but the humanistic and emotional aspects of medicine.

The importance of neurology field exposure in medical education depends on students being able to develop the necessary patient-centered skills to communicate and form doctor-patient relationships with a wide range of patients [23]. In our MTP session, students had many opportunities to interact with the patients, which allowed them to reinforce concepts learned, including identifying the level of injury, spasticity, signs and triggers of AD, and loss of bowel and bladder control, while reminding them why what they are learning is important. Similar to experiential learning theories, the MTP session emphasizes learning through patient encounters early in the curriculum, whereby the experience broadens and deepen the concepts learned in class and the post-session quiz provided opportunities for reflection and further conceptualization [25]. Additionally, the session incorporated elements of social theories of learning, focusing on social interactions, the patients as persons, and the spinal cord injury community. Gain of knowledge was demonstrated by their performance in the post-session quiz and the final exam. Our results support prior reports of enhanced learning outcomes associated with the incorporation of patient panels [24, 26]. It is possible that by recalling patients stories, students were able to make the appropriate connections and apply their knowledge to new patient scenarios in the assessments. By correctly identifying life-threatening situations on examinations, students could later apply these same concepts to real-life patients in the hospital setting. Noteworthy, student engagement and acquisition of knowledge may have been influenced by the incorporation of a graded quiz at the end of the session [25]. Although the performance of students on the final exam in a question regarding the identification of AD was above the national average, one question is not enough to make a strong conclusion.

In agreement with prior reports, we found that interacting with patients was associated with high learners satisfaction [24]. Most students considered that the session helped them understand SCI sequelae and its impact on patients. The highest level of satisfaction was regarding how well the MTP session helped students recognize AD and its triggers. This was not surprising to us since this was the core topic of the session, with more class time dedicated to it. In contrast, although spasticity was discussed and shown in class, there might have been difficult for all students to appreciate the demonstration in the large classroom, which may explain the lower satisfaction compared to AD. It is possible that this type of demonstration may be more meaningful if done within small groups. Given that the level of student satisfaction correlated with focus of the session, the time spent on each topic and questions prepared can be adjusted based on the specific learning objectives and goals of the session.

To our surprise, the level of satisfaction with the session for the second academic year was lower than the first year of implementation, despite no changes in knowledge acquisition. The major difference between both sessions was the number of patients, time of the session and student attendance (less in all counts for the class with lower satisfaction). There are some students in the second year who did not attend the session and yet filled out the satisfaction survey. Although our study design did not account for the reasons for these differences, one possibility is that some students not attending the session felt that 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 might be other differences between the sessions that may have accounted for the different levels of satisfaction. For example, there were discussions that happened in the first, but not the second year, including topics related to nutrition and foods that made bowel problems worse, sex life and orgasm as a trigger for AD, and the use of endocannabinoids for pain after SCI. These discussions incited a lot of interest in students and prompted them to participate more; this may have provided a greater holistic understanding of patients living with SCI and the impact of the disability on everyday life. In addition, one of the patients in the first session is a vocal advocate for people living with SCI and had ample public speaking experience, which may 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 assure that our patients had a meaningful and rewarding encounter with students. Like prior reports, the primary role of our patient was patient-teacher and we purposely attempted to establish a partnership with patients where they felt involved and empowered [29] During the session planning, the patients were extensively briefed on the goals 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 the teaching of basic elements of their condition, for example, about neurogenic bladder, catheterization, mechanism of action of the drug, etc. Emphasis was made on the proper communication language when interacting with people with disabilities. For example, patients gave student resources and tips during the session (e.g., avoid wheelchair bound, disabled person, handicapped, etc.).

Based on our experience, we recommend that all patients should be trained before the session and have at least one rehearsal session. Although advocates with public speaking experience might be preferred in some settings, other patients can be selected as long as they are invested in the learning process. Patients should not only be comfortable with the session format and content beforehand, but they should also be empowered to suggest and make changes that they believe are important to communicate with students. Furthermore, the session should incorporate opportunities that broaden students understanding of the condition beyond the concepts learned in class, such as the impact of the condition on everyday life. We believe it is important to provide opportunities for ample interactions between students and patients that help create positive connections and increase students comfort level when talking to people with disability. These observations are in agreement with prior reports in the literature [24]. Even though our session focused primarily on AD, the same principles can be applied to other conditions/diseases.

Our results have several limitations. We evaluated only short-term knowledge acquisition, we used a small number of questions, and there was no control group to evaluate the effectiveness of the MTP compared to other learning strategies. Although comparing pedagogies was not our objective, we cannot rule out that other methods might be as effective in helping students acquire the knowledge. Nonetheless, the MTP was originally designed to complement rather than substitute and may have benefits beyond imparting knowledge. This type of patient encounter may result in enhanced long-term retention, and/or changes in behavior or practice that can be transferred to patient care. This is an important question that merits more research, involving longer time points, adequate controls, and possibly more MTP sessions.

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Meet the patient session: a strategy to teach medical students ... - BMC Medical Education