A Handbook for Teaching and Learning in Higher Education Enhancing academic and Practice

432 ❘
Teaching in the disciplines
PATIENT-CENTRED TEACHING AND LEARNING
Clinical teaching is a three-way dynamic between teacher, patient and student. It occurs
in the workplace environment. As the controlling factor, the teacher is obliged to maximise
the situation from all perspectives. With earlier clinical exposure, students may be forced
to develop a more balanced approach to the acquisition of knowledge, technical skills and
professional attitudes and behaviours; it is important in initiating students into a
community of practice.
The patient
Whenever and wherever clinical teaching occurs the patient is the most vulnerable of the
three parties. Most medical patients find clinical teaching extremely rewarding, often
commenting that they feel students ‘have to learn’. In dentistry there is a slightly different
relationship. Patients receive treatment from a novice under instruction. Their
vulnerability is magnified and the teacher has added (statutory) responsibilities. The
patient must be reassured that a watchful eye is being cast. In both cases, patients’ attitude
towards being used in teaching should always be respected and it should be reinforced
that, whatever their decision, it will not affect their treatment and care. Within any
teaching centre, patients should be made aware that the facility is a teaching environment
and that students may be present, or, in the case of dental students, carrying out the
required treatment. This allows patients to prepare for the initial encounter and to raise
any anxieties they may have. At all times one needs to keep the patient informed, reach
mutual agreement about the session, and most importantly, ensure that patient privacy
and dignity are maintained. One should explain to the medical patient the number and
level of the students who will be in attendance and the patient’s proposed role. Verbal
agreement should be obtained and documented. Dental sessions differ in that the patient
is being treated and followed up by the student under the supervision of the teacher. The
dental supervisor must approve the proposed treatment, ensure that it has been explained
correctly to the patient and review its course and outcomes.
The student
With new curricula in the UK, students from a very early stage of their training will meet
the challenges of the clinical environment. As with the patient, good preparation reduces
anxieties, and sets out a clear level of professional conduct.
Before students are ready to interact with patients they need to practise basic clinical
and communication skills. This should occur in a safe, supportive environment
such as that of a clinical skills centre (see next section). For dental students, competence
in core skills will have to be demonstrated prior to their introduction to the clinical
arena.