Whether they are aware of it or not, I think health professions educators like myself teach with the notion that some of our students today will be the very nurse or physician caring for us in the future because ultimately, we all will end up as patients – sooner or later. In didactics and in clinicals, the patient’s perspective is not fully grasped, even as the faculty give a cursory attempt to present the hospital experience from the vantage point of the patient. This dynamics is transformed when the faculty is concurrently also a “patient,” living with the same conditions they are teaching in class. As I enter my 26th year as a nursing faculty, I realize that I am sharing more of my personal experiences as a patient, as I acquire comorbidities over the years, not only to offer a précis of potential applications of the finer points of nursing care, but to make authentic teaching come to life.
Authentic teaching
A faculty can teach for themselves, and feel self-absorbed on the vastness of their accumulated knowledge, or they can teach for the learners, using personal narratives as means for authentic education. I recently told my students in the pharmacology course I teach that I have been spared from COVID-19 in the ongoing pandemic, but all the masking and social distancing did not protect me from hypertension. Two prescriptions and eight months later, my blood pressure is back to normal. I can now teach with authenticity the side effects of calcium channel blockers (leg edema) and angiotensin receptor blockers (dizziness) because I’ve been there, done that, and took the medications as prescribed. In the past, I parroted during my lectures the oft-repeated patient instructions: eat healthy and exercise more. This time, I teach them with candor and sincerity knowing how difficult they are to achieve.
Authentic teaching calls for genuinely caring for the subject matter one is teaching. This can be tough since no one is an expert in all subjects. I have been teaching hearing loss as part of the geriatric course for many semesters and didn’t really care much about it. Then, I got diagnosed with sensorineural hearing loss. When the doctor told me the price tag of the snazzy pair I got was $8,000 and the insurance does not cover hearing aids (I heard it right without the device), I could now understand why only twenty percent of adults who could benefit from a hearing aid currently wear one.
When I tell my students that hearing loss is more than just an annoying inconvenience (I found myself asking “can you say that again please” more often during class in pre-COVID times), and that it is associated with cognitive decline, depression, heart disease, and overall poor well-being, I am inviting my students to share a contextualized life experience as I inwardly reflect how my career trajectory would be altered if I became deaf. Authentic teaching gives the teacher an opportunity to weigh and consider with the students, not just the topic at hand but life lessons in general.
Patients as educators
“It is a safe rule to have no teaching without a patient for a text, and the best teaching is that taught by the patient himself”
-Sir William Osler
Traditionally, the education of healthcare workers requires interactions with a real patient (not the mannequin in high-fidelity simulation or patient actors) during clinical practicum, externship, and clerkship. Lately, there have been increasing efforts, particularly in medical education, to meaningfully use real patients as educators. This initiative is based on the notion that people with chronic conditions have personalized expertise in living with their diagnoses that adds value to interprofessional education. Using patients as educators gives credence to the lofty aim of humanistic medicine. It is assumed that using patients as educators can positively impact healthcare workers’ attitude, cultivate empathy, and empower the patient.
In 2013, the New York Times published an article about Martha Keochareon, a nurse dying of pancreatic cancer who reached out to her alma mater, offering to welcome nursing students to her home to give them an experience in end-of-life care. (https://www.nytimes.com/2013/01/11/us/fatally-ill-and-making-herself-the-lesson.html). Miss Keochareon’s generosity is uncommon because she personally volunteered to be both the teacher and the lesson in death and dying. In teaching hospitals across the world, there are countless patients, involuntarily or otherwise, who are educating future healthcare providers. What the students’ need to do is listen to patients’ voices and honor their contribution to authentic education.
Let me tell you something
In my teachings, I share many patient and provider stories from my 19 years experience as a staff nurse. Over the years, I have added my own personal narrative as I experience loss and chronic conditions. I do this not to dazzle or distract but simply because storytelling comes naturally to me. When I told my students, in context, that I lost one of my nephews to suicide, it is not a sympathy bait, but my way to declare my humanity, that I too have to muddle through. As a faculty, I use the sum of all and parts of my lived experiences – both as a citizen and as a clinician – to create authentic learning. It requires a certain openness to be vulnerable and risk a negative student evaluation because some students consider stories as time wasted. But I still think it is worth the effort, because one does not teach or learn by books alone. Lectures are invariably bibliographic, but lessons are inevitably biographic. When genuine personal stories are told with honesty it may even inspire the students to pursue their own authenticity. Can you imagine?
References
Towle A, Godolphin W. Patients as educators: interprofessional learning for patient-centered care. Med Teach. 2013;35(3):219-225. doi:10.3109/0142159X.2012.737966.
Kreber C, Klampfleitner M, McCune V, Bayne S, Knottenble M. What do you mean by ‘authentic’? A comparative review of the literature on conceptions of authenticity in teaching. Adult Education Quarterly, Nov 2007;58(1): 22-44.
Fidelindo Lim is a clinical associate professor at New York University – Rory Meyers College of Nursing.
