What Are the Patient and Medical Student Perspectives on the Learning Needs and Expectations of Training of Future Doctors in Healthcare for Individuals With Learning Differences?

A learning difference or disability is a reduction in intellectual ability. It causes lifelong difficulty with everyday activities. Different individuals require different levels of support. Individuals with learning disability may also have learning difficulties and mental health problems, but they do not always co-exist. Learning difficulties affect the way someone processes information. They are not related to intelligence but can affect learning and education. Examples include dyslexia and attention deficit hyperactivity disorder (ADHD). People with learning differences can experience higher rates of mental and physical ill-health. The life expectancy of individuals with learning difficulties is shorter than the average for the population. This is related to access and experience of health care. Poor quality care severely affects outcomes for these patients, for example during Covid-19. The rate of avoidable death in people with learning disabilities is twice that of the general population. These patients may experience discrimination affecting their healthcare. Diagnostic overshadowing in which new mental and physical symptoms are wrongly attributed to an existing condition or disability are more common in individuals with learning differences and contributes to poorer outcomes.

The lack of training for healthcare staff, both pre- and post-qualification, is recognised as contributing to poor-quality care of patients with learning differences. The UK General Medical Council (GMC) recognises the need to address this in its ethical guidance to doctors. Furthermore, it has developed a learning package to guide practitioners. The GMC recommends staff training which is led by individuals with a learning difference. There is variation in educational interventions for teaching medical students about learning differences. These include classroom-based teaching, simulation with actors, individual placements, home visits and panel discussions. These interventions tend to be teaching about the patient rather than with the patient. Furthermore, study quality is poor with use of non-validated measures making assessments problematic.

Patients are stakeholders and the greatest experts in their own healthcare needs. Leaving no-one behind means listening to all patients, engaging in dialogue and learning to see things from the patient's perspective. This study will examine the co-production of a volunteer-student teaching session to improve the understanding of future doctors of this important area.

Co-production in healthcare planning and delivery is well established including in medical education. The School of Medicine at the University of Nottingham has a long-standing reputation for working in partnership with members of the public. People have contributed to teaching and assessment in innovative ways, and the School has regularly jointly produced publications and co-presented at conferences. Engagement with patients recognises their dignity. It integrates the four ethical pillars - beneficence (do good), non-maleficence (do no harm), autonomy - (self-determination, shared decision-making) and justice (fairness to all).

This study examines patient-student co-production in the context of educating medical students through collaboration with volunteers who have the lived experience of a learning difference. The collaboration will assess this process from conception to identification of volunteer experience and student learning needs, preparation of resources, delivery of an interactive session working with volunteers and reflection on the strengths and limitations of the educational intervention. The study will assist development of longitudinal resources for supporting students' ability to learn to provide high quality care holistic for individuals with learning differences.