"I've Never Really Thought about This…" - The Complexity of Patient Involvement in Education from the Teachers' Point of View.

Introduction: Patient involvement in health professions education (HPE) often takes the form of isolated, small-scale activities, where teachers' initiatives largely determine whether and how patients are included. Understanding how teachers make sense of patient involvement is therefore crucial for strengthening and sustaining this practice in HPE. Using a phenomenographic approach, our aim was to explore how teachers understand patient involvement in HPE and visualize these interrelated understandings in an outcome space. Methods: We conducted semi-structured interviews with 20 teachers experienced in working with patient involvement across eight different HPE programs at one university. The interview guide was developed within the research group, in dialogue with a patient representative. Results: We identified four qualitatively different ways in which teachers understand patient involvement: as a way to 1) create variation in education, 2) improve education, 3) improve health care or 4) improve society. These four categories were comprised of seven themes of expanding awareness: the role of the patient, the role of the student, the role of the teacher, role of education, interaction between patient and student, view of workplace learning and teachers' perceived agency. Discussion and conclusion: Our findings suggest that there is considerable complexity in how teachers understand the purpose and value of patient involvement in education. These differences will influence why, how, and to what extent patients are involved in HPE. Striving towards a more complex understanding may support more beneficial, sustainable and meaningful patient involvement. Further research should explore how different stakeholders' understandings influence the practice of patient involvement in HPE.