Exploring partnerships for patients and carers in professional healthcare training

Healthcare educators continue to strive towards aspirations for involving patients as ‘equal partners’ in curriculum design, delivery and management, guided by well-established frameworks proposing a hierarchy of involvement. We do not yet understand what these partnerships mean for all stakeholders and the processes needed to support them. Theory can help to illuminate solutions to these gaps in the evidence-base. This study aimed to understand what it means to key stakeholders to involve patients and carers as ‘equal partners’ within one community of healthcare educators.

A qualitative case study design was adopted, underpinned by Communities of Practice theory. Semi-structured interviews were conducted with patients and carers (n=10) and educators (n=10) from across a Medical and a Healthcare School. Five focus groups were held with penultimate-year students (n=20) from across both Schools. Data were analysed using reflexive thematic analysis informed by Communities of Practice theory.

The analysis resulted in three overarching themes: Boundaries, Identity and Understanding Partnership. There are boundaries between patients, educators and students in healthcare education which can hinder meaningful patient involvement. Boundaries are marked through differences in knowledge, a lack of shared vision and issues around trust. Stakeholders experience tensions of identity when they come together across boundaries, revealing insights into their construction of the ‘patient’ identity. All stakeholders agreed that ‘equal’ partnerships were neither feasible nor desirable. Instead of being about equality, stakeholders considered that true, meaningful partnerships were about valuing patients and carers at any level of involvement.

Applying Communities of Practice theory has, for the first time, illuminated issues of boundary and identity that stakeholders experience when patients and carers are involved in healthcare education. The findings challenge a hierarchical set of steps towards involving patients as ‘equal partners’ in education and deepen understandings of the processes needed to support patient involvement in programme delivery systems.