October 2019 What I’m Thinking About…

How does Patient Inclusion in Medical Learning Environments Shift the Patient, Learner and Attending Experience?

Ms. Carolyn Canfield, Drs. Cary Cuncic & Cheryl Holmes

Date: October 1, 2019

Time: 12:00 – 1:30PM

  • formal presentations and discussion from 12:00 – 1:30pm, with a pause at 1:00pm for those who need to leave early
  • feel free to bring a bagged lunch


  • LSC CMR 1312 (host venue)
  • DHCC 2262
  • SHY E404
  • NHSC 9-374

Remote Access: Additional access options are available. Please email ches.communications@ubc.ca to request remote access.


Although much has been written about the medical learning environment, the patient, who is the focus of our care, has been systematically excluded from this discourse. The purpose of this study was to explore the role of the patient as an active participant with agency in an authentic medical learning environment from the standpoint of the learner, the faculty and most importantly the patient. We hoped to gain insight into the reinforcement of positive professional values such as patient-centred behaviours and a respectful environment. The study recruited attending physicians and medical trainees to adopt a “patient-centered clinic” approach where all case presentations were conducted in examination rooms with the patient, as opposed to a conference room. Using a design-based research methodology, semi-structured interviews explored the impact of the new learning environment. After each week of interviews, the study members discussed insights and the interview questions were refined. The preliminary sample included of the study with 5 attending physicians, 8 trainees, 5 patients and 1 family member. Results revealed three themes: 1. The teaching model allowed for a more patient-centered and inclusive health care environment; 2. Attending physicians and medical trainees reported that presenting cases with the patient present challenged normal teaching practices and may have limited teaching opportunities; and 3. Although it was difficult to ascertain the effect on professionalism, patients felt more respected. This study provides a valuable platform for exploring the evolution of a positive learning environment with the lens of patient agency and centeredness.


  1. How we might fuel a culture of continuous learning to improve the positive impacts of clinical training environments with patients fully present
  2. How me might gain a better understanding of the drivers and barriers for such 3-way co-learning
  3. How we might anchor early findings from our study to transform culture

Accredited by UBC CPD



The University of British Columbia Division of Continuing Professional Development (UBC CPD) is fully accredited by the Committee on Accreditation of Continuing Medical Education (CACME) to provide study credits for continuing medical education for physicians. This program meets the certification criteria of the College of Family Physicians of Canada and has been certified by UBC CPD for up to 18 (1.5 per session) Mainpro+ Group Learning credits. Each physician should claim only those credits accrued through participation in the activity.

RCPSC Accreditation

What I’m Thinking About… is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.