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Dilemmas of Representation: Patient Engagement in Health Professions Education

Rowland, Paula OT Reg (Ont), PhD; Kumagai, Arno K. MD

doi: 10.1097/ACM.0000000000001971
Perspective: PDF Only

The role of the patient in bedside teaching has long been a matter of consideration in health professions education. Recent iterations of patient engagement include patients as storytellers, members of curriculum planning committees, guest lecturers, and health mentors. While these forms of patient engagement are reported to have many benefits for learners, educators, and the patients themselves, there is concern that such programs may not be representative of the diversity of patients that health care professionals will encounter throughout their careers. This problem of representation has vexed not only educators but also sociologists and political scientists studying patients’ and the public’s involvement in arenas such as health services research, policy, and organizational design.

In this Perspective, the authors build on these sociological and political science approaches to expand our understanding of the problem of representation in patient engage-ment. In doing so, the authors’ reconfiguration of the problem sheds new light on the dilemma of representation. They argue for an understanding of representation that not only is inclusive of who is being represented but that also takes seriously what is being represented, how, and why. This argument has implications for educators, learners, administrators, and patient participants.

P. Rowland is assistant professor and scientist, Department of Occupational Science and Occupational Therapy, University of Toronto (UT) Faculty of Medicine, Toronto, Ontario, Canada. She is also cross-appointed researcher, Wilson Centre, UT, Toronto, Ontario, Canada.

A.K. Kumagai is vice chair for education, Department of Medicine, University of Toronto (UT) Faculty of Medicine, and F.M. Hill Chair in Humanism Education, Women’s College Hospital and UT, Toronto, Ontario, Canada. He is also cross-appointed researcher, Wilson Centre, UT, Toronto, Ontario, Canada.

Funding/Support: The authors would like to acknowledge and thank the AMS Phoenix Project for P. Rowland’s fellowship funding. A.K. Kumagai would like to acknowledge and thank the F.M. Hill Foundation for support of his work.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Disclaimer: The authors alone are responsible for the content and writing of this article.

Correspondence should be addressed to Paula Rowland, University Health Network, 200 Elizabeth Ave., Eaton North, 1-812, Toronto, Ontario, Canada, M5G 2C4; telephone: (416) 340-4800, ext. 3716; e-mail:

© 2018 by the Association of American Medical Colleges