The hunter and the lion: Amplifying health care consumers' voices in health care education.

Until the lion learns to write, every story will glorify the hunter. (African proverb)

Health professions education (HPE) is designed and developed to include rich experiential curricula drawing on the expertise of clinicians, educators, academics and students working together to enable and equip students to meet core health professional competencies. Learning occurs in university settings and a range of diverse workplace‐based settings. While educational design and learning and teaching approaches have evolved over the decades, they predominantly, still ‘glorify the hunter’, the voices of expert academics, educators and clinicians rather than the lion, who in this African proverb represents the patient or health care consumer.

While educational design and learning and teaching approaches have evolved over the decades, they predominantly, still ‘glorify the hunter’.

It is important to amplify the voice of the lion, in part, because growing evidence suggests we should be paying more attention to sociocultural factors in HPE and framing health care professional learning and practice across broader landscapes of practice. Conceptions of health care professionalism, as a case in point, have also evolved to emphasise paying attention to educational strategies that engage learners in developing their professional identities as a means to facilitate successful transition from student to professional. Professionalism, in other words, is a dynamic construct, with understandings varying across time, health care contexts and settings, cultures, multidisciplinary teams and professions. Despite professionalism being described in competency standards, with codes of conduct and professional standards established across all health professions, the literature has predominantly privileged and focused on examining perspectives of academics, clinicians and students, rather than patients. That truth offers a reflection of the inherent power imbalances and hierarchy that exist across health care, including HPE. In this issue, Haney and colleagues contribute to rectifying the problem by using grounded theory to advance our understandings of medical students' professionalism from the patient perspective.

Growing evidence suggests we should be paying more attention to sociocultural factors in HPE.

It is therefore vital that we continue efforts to move health care consumers from the periphery of HPE to the centre of the education process, amplifying their perspectives and strengthening their voices. We believe this can be achieved through co‐designing HPE in a deliberate effort to deconstruct and reposition paternalistic, hierarchical relational patterns towards more humanistic models of health care. As Haney and colleagues conclude, ‘knowing what patients perceive as important will allow educational and assessment efforts to be refined to reflect their values’. Co‐designed HPE offers a crucial formative step in preparing students to learn from, collaborate with and understand how to partner with patients in their future practice, a phenomenon described as ‘imprinting’—an important experiential learning process that drives future practice behaviours.

Co‐designed HPE offers a crucial formative step in preparing students to learn from, collaborate with and understand how to partner with patients in their future practice.

So how can we amplify the voices of ‘lions’ in HPE? We would start to answer that question by offering three examples of co‐designed curricula aimed at teaching dimensions of professionalism. Each can be adapted into existing health care education to remedy the ‘blind spots’ Haney and colleagues refer to, ensuring we support learners to develop professional identities, professionalism and person‐centred practice in meaningful ways.

So how can we amplify the voices of ‘lions’ in HPE?

Rosalie, an Indigenous Noongar woman, was invited to co‐design a strengths‐based, visual narrative portrait for health workforce education. Cultural artefacts and audio‐recorded Indigenous narratives were utilised in the education resource to foster cultural capability. The Depth of Field health humanities education methodology (see https://vimeo.com/385779412) was used to stimulate new and different ways of seeing, knowing and understandings that occur when we create culturally safe spaces for learners to sit in ‘the uncomfortable tension that can be felt while walking through difficult historical truths’. At our institution, interactive online case studies referred to as Integrating Science and Practice are used to help students explore and apply theory and skills in their field of study. In performing a case study, students submit a Clinical Action Plan (CAP) that is followed by immediate feedback in the form of a video‐recorded CAP response by an expert clinician. Students are then prompted to submit a reflective analysis comparing the expert response with their own original CAP. Only recently did we realise the patient's voice was missing, thus raising concern that we were further perpetuating relational power imbalances. To rectify this, we video‐recorded health care consumers' lived experience to parallel the clinician response to ensure our education design is sending a clear message that we value consumers as equal partners in their health care. Other ways we have infused the lived experience of health care consumers is by encouraging health professional learners to integrate the ‘art’ and ‘science’ of health care. Examples include using magnetic resonance imaging (MRI) images and poetry to bridge clinical and human experiences of stroke recovery that helps move learners beyond ‘diagnosis’ to more person‐centred care. Emotional and embodied (see https://vimeo.com/454585619), this co‐designed resource encourages learners to pause, connect and reflect on the fragility of human life with emphasis placed on co‐design to remind us of health professionals' core values of empathy, service and respect for patients.

Professionalism as cultural capability

Professionalism as hierarchy

Professionalism as person centredness

As clinicians, educators, academics and researchers, it is a matter of care, respect and integrity that we work together to amplify lions' voices in HPE. The results from Haney et al.'s study confirm that patients trust both the health care system and the education process, so why are we not honouring that trust by working together to co‐design education that better aligns with patients' values and expectations? As demonstrated in the learning and teaching professionalism examples above, creating rich learning opportunities to challenge presiding ‘knowledge’ in HPE through co‐designing curriculum is both possible and has the potential to transform traditional, hierarchal health care relationships from transactional to transformative. HPE has glorified the ‘hunter’ for too long. It is time to hear the lion roar!

As clinicians, educators, academics and researchers, it is a matter of care, respect and integrity that we work together to amplify lions' voices in HPE.