12 Tips for Centering Patient Voices through “Lived Experience Panels” in Preclinical Undergraduate Medical Education

Background: Integrating patient narratives into medical education enhances understanding of person-centered care, empathy, and the human experience of illness. This paper explores the implementation of lived experience panels (LEPs) in preclinical medical education. Aims & Description: Twelve strategies for effective LEP integration are presented, emphasizing thoughtful curation of panelists, timing considerations, vulnerability cultivation, and empowerment of marginalized voices. The paper outlines leveraging virtual platforms, skillful facilitation, student and patient preparation, post-session support, and debriefing mechanisms. Experiences from the University of Texas Branch at Galveston are showcased. Conclusion: The incorporation of LEPs into medical education holds immense potential for benefiting both learners and patients. Ensuring intentional and sensitive inclusion of these panels is paramount for the development of impactful curricula. By incorporating patient voices into medical education, we can nurture empathy, reinforce person-centered care principles, and cultivate authentic connections among learners, ultimately facilitating a transformative shift in the dynamics of the physician-patient relationship.


Introduction
Authentically listening to the real-life experiences of patients occupies a unique space at the convergence of cultivating person-centered care, nurturing empathy, fostering rapport and connection and reflecting on what it means to be a physician for learners in preclinical undergraduate medical education.As a crucial branch point from which multiple curricula can be developed, intentionally integrating patient voices into formal medical education curricula early on offers benefits to both learners and patients.
Patients, acting as educators, self-experts and storytellers, contextualize their illness within the fabric of their lives.Leveraging the connection of storytelling, they find empowerment in sharing their life histories and the opportunity to sculpt their own narratives.Their status for learners rises from someone that is acted upon by health care professionals to someone who has agency and is a fully multidimensional person with hopes, fears, and nuance inherent in their humanity.Learners gain invaluable insights into the patient's experience of living with a specific disease or caring for someone with a chronic illness, understanding the profound impact of social determinants of health and psychosocial factors [1][2][3] .
Incorporating patient voices into medical education has many far-reaching benefits for learners.They gain insight into the patient experience, perspective of disease and health care, recognize the social context of illness, and acquire an understanding of the broader culture of health, healthcare, and medicine.Providing space for uninterrupted storytelling allows faculty to demonstrate role modeling of communication skills, empathy, and professional attitudes while reinforcing concepts of person-centered care [4][5][6] .
Patient narratives serve as a powerful tool not only for students, but also for the patients themselves.Those who are willing to share their stories often experience improved self-esteem, feelings of empowerment, and the ability to positively shape future patient experiences by educating healthcare professionals.By reflecting on their illness experience, patients can reframe and sculpt their illness narrative, gain deeper insight into their health, and seek support from peers.The prospect of shaping learner attitudes and beliefs can provide great personal satisfaction to the patient [6][7][8] .
At the University of Texas Medical Branch at Galveston, we created a series of lived experience panels (i.e LEPs) featuring real patients, sometimes alongside their caregivers and interprofessional care team, who shared their life stories with vulnerability, honesty, and bravery.We created different panel sessions on the themes of Incarceration, LGBTQI+ care, chronic disease, and disability that were facilitated by experts.Table 1 shows the session pre-work and format (see Table 1).LEP session themes can be expanded to include any relevant topics centered on the patient experience.The LEPs can serve as a model to integrate patient voices to stimulate further conversation and curricula on a wide range of topics and competencies.
In the subsequent twelve tips, we aim to offer guidance for effectively implementing lived experience panels in medical school curricula.2. Consider timing: When scheduling sessions, take into account the mental, cognitive and emotional bandwidth of the students in conjunction with their other coursework to ensure an optimal learning environment.Align the sessions with the curriculum and the students' current learning objectives for maximal impact.
3. Create conditions for vulnerability: Create an environment that allows for vulnerability from both the panelists and the students.Frame the session with thoughtful, pre-curated questions that encourage meaningful dialogue and open exchange.
4. Promote patient expertise: Cultivate a shared decision-making framework placing patients at the center of their care that regards them as their own experts.

Empower historically marginalized communities:
Carefully curate panelists from marginalized communities and allow them the space to share their narratives authentically.

Leverage virtual platforms: Utilize virtual platforms
to create comfort for panelists, expand recruitment of panelists from larger geographic areas and offer students a glimpse of patients in their own environment.Additionally, ensure sessions are not recorded to allow for greater confidentiality.11.Debrief with patient panelists and curators: Allow for a debriefing period with panelists and curators to ensure the session goal was achieved, their experience was positive, and their unique perspectives were valued.Additionally, create a mechanism for students to show their appreciation.
12. Collaborate with your local community: Foster authentic relationships with people both inside and outside of the medical community and create a network in your local community to further enrich the lived experience panels.

Conclusion
Integrating lived experience panels into medical education can have numerous benefits for both learners and patients.Thoughtful, intentional, and sensitive inclusion of these panels is essential for creating meaningful curricula.By incorporating patient voices into medical education, we can foster empathy, person-centered care, and authentic connection among learners, which has the potential to transform the physician-patient relationship.

Mantoa Mokhachane
University of Witwatersrand, Johannesburg, South Africa Aviwe Mgobozi Clinical Associates, School of Clinical Medicine, University of Witwatersrand, Johannesburg, Gauteng, South Africa The article discusses an exciting and innovative pedagogical approach to health professions education.Strengthening the voices of patients through lived experience panels is beneficial to both patients and students.It is a useful method for patients as they gain deeper insights into their own experiences and illnesses.On the other hand, it is beneficial for students to practice patient centred consultations and obtain deeper insights into conditions, opinions and views from patients.This yields empathy and a greater connection.
The 12 tips are useful to outline the considerations for implementing the lived experience panels for health professions education.It is unclear whether the 12 tips originate from a research study or whether it is based on the perceptions of the authors following the implementation of the lived experience panels.The paper aims to outline the "leveraging of the virtual platforms, skilful facilitation, student and patient preparedness, post-session support, and debriefing mechanisms".However, the aim has been partially addressed as there are no practical measures suggested for the reader to fulfil the mentioned steps towards a successful lived experience panel.The aims and objectives were only mentioned in the abstract, it is not clear whether this was intentional because of word limit or whether the authors were avoiding repetition.
It is insightful to see the various panels and sessions which were centred around various objectives and experiences namely incarceration, LGBTQI, Chronic disease, and disability.It is unclear how panellists were selected for each panel and the objectives the students were anticipated to obtain from each session.
Sharing the logistics would be useful to the reader for replication of the method in different environments.The student numbers were not included and the administration requirements for the successful execution of the lived experience panel are unclear.In Table 1 LEP sessions; in the session format column, it is not clear whether patients are participants, especially the incarceration section.In the disability LEP session, it is not clear whether there is more than one family or not.If there is more than one family, it is not clear how their incorporation is facilitated or handled.
The sequence of the 12 tips would benefit the reader if there was a chronological order of implementing the lived experience panels, starting with considerations for the planning phase, the execution, and lastly the post-panel phase.This would enhance the flow and coherence upon reading the tips.In the third tip, it is mentioned that they 'create conditions for vulnerability', it is not clear how that is done.In the fourth tip patient's expertise is meant to be promoted, as this was not explicit in the LEP sessions Table .How are the historically marginalized communities empowered, as mentioned in the fifth tip.
The 12 tips are general measures and considerations.Linking the 12 tips to the lived experience panels as mentioned earlier in the article would increase the relatability of the article and ground the concept with practical measures based on the real activity.More examples are required so as to address the void of the reader's curiosity on the practical steps taken to facilitate the activity, and larger pedagogical approach from the time of initiation to debriefing and assessing the impact of the event.

Are all factual statements correct and adequately supported by citations? Yes
Are arguments sufficiently supported by evidence from the published literature and/or the authors' practice?Yes If evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?Partly

Are the conclusions drawn balanced and justified on the basis of the presented arguments? Partly
Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Professionalism and Professional Identity formation. Medical Education
We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.Reviewer Expertise: Medical humanities I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Read Importance of Physician Listening article 1. Introduction of all participants 2. Mother tells the story of her daughter 3. Care team tells their perspective (MD, OT, SW) 4. Mom signs off 5. Q&A with students and care team Disability • View a video on www.positiveexposure.organd answer prompts 1.Short introduction 2. Introduction of all patients and their families 3.Each family tells their story 4. Families are invited to give advice to future doctors 5. Brief Q&A 6. Didactic of best practices *This session was followed by a formal Allies in Health LGBTQI+ training 1. Curate panelists thoughtfully: Carefully select panelists representing diverse patient experiences and perspectives.Consider inviting people from outside of the medical community to broaden the scope of the conversation.
Are the conclusions drawn balanced and justified on the basis of the presented arguments?Conclusions presented would be better supported by including in the body of the article the specific benefits of incorporating the LEP model in the curriculum.Is the topic of the practical tips discussed accurately in the context of the current literature YesAre all factual statements correct and adequately supported by citations?YesAre arguments sufficiently supported by evidence from the published literature and/or the authors' practice?YesIf evidence from practice is presented, are all the underlying source data available to ensure full reproducibility?YesAre the conclusions drawn balanced and justified on the basis of the presented arguments?YesCompeting Interests: No competing interests were disclosed.

Table 1 . LEP sessions at UTMB. Session Theme Pre-work for students Session Format
Reviewer Report 20 June 2024 https://doi.org/10.21956/mep.21688.r37328This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This is a valuable addition to the literature.While including patient voices in medical education is well supported in the current literature, information on how to support and operationalize this process is limited.These tips add to the existing literature base.Consider the use of language (eg Groups that have been historically marginalized vs groups that have been marginalized): Citations provided in the article support including patient voices in medical education but do not specify or reference Lived Experience Panels (LEP) as a model that can be an effective approach.It would be helpful to know what led to introducing LEP as a potential model for incorporating patient narratives.Method or source data was not presented.There was no indication if surveys or other methods which could be reproduced were used to gather evidence to develop the tips shared.The relevance of Table1could be strengthened by the inclusion of objectives linked to medical education competencies.