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Seniors can now expect to have multiple conditions in later life and have to deal with multiple professionals across many institutions. Comorbidity and chronic diseases, often with complicating factors such as depression, are driving the need for change amongst healthcare professionals to more person-centred care.

This training is based on a generic learning framework that is accessible for healthcare students and professionals from any background and at various stages of their careers. Training needs do not have to be just healthcare related, they can also be organizational. The training uses patient and citizen stories from many different settings, as healthcare has no boundaries. The stories are translated into the different languages of the platform and function both as general stories about healthcare that we can all relate to, as well as demonstrating specific issues, relating to particular regions and local practices. The stories are available in audio and text and there are also digital stories to use.

The training consists of six modules, which are designed, in our spiral learning framework, to follow on from each other. A protocol included in the introductory pre-module 0, enables trainees to collect their own citizens? stories, in their own settings. This facilitates trainees to collect and interpret locally specific citizen stories during the training. Within the spiral learning framework trainees can follow certain modules, in a shorter training, or follow all six sequentially to optimize the learning gains overall. Each module has a choice of exercises, both foundation exercises and some more advanced, which trainees do in groups, to support the dialogic aspect of the training. There are associated readings and resources to access on the site.

Person-centred care can therefore be considered as core knowledge for professionals, but also difficult to teach. By utilising well-researched pedagogic models focused on stories in our training, our bespoke platform provides accessible training that will provide key skills to support person-centred care.

The key learning process is critical reflective learning, based on dialogue around the interpretation of stories.

Following this training healthcare professionals will gain knowledge and skills necessary in improving person-centred care, by increasing their awareness of what this means in practice.

This means a way of thinking and perceiving that calls on our ability to question things and to challenge assumptions, including our own. It also means recognizing contexts that inform views and understanding the world holistically and meaningfully. Making prior learning the starting point for new learning is important and the training has no barrier to entry. The learning framework is based on narrative pedagogy, transformative learning theory and expansive learning, taking account of professionals? expectations, bodies of knowledge and mindsets. Mental models, or mindsets, affect sense-making. The over-arching aim is to take participants from categorical, which is routine, to cognizant, or reflective, thinking. Categorical thinking characterizes routine performance and working under pressure, whilst being more resistant to change, whilst cognizant, or reflective thinking, denotes a high level of cognitive responsiveness and flexibility. The learning context creates the space in which this can happen, through a series of sequential activities, demonstrated in our spiral learning framework, based on dialogue and reflection. The requirements for the training are therefore an environment conducive for dialogue and the story-based resources for the modules, which are either provided in the learning materials, or collected by trainees as part of module 0.

Professionals will be able to integrate the priorities, capabilities and desires of older adults into their practice, better understanding how lifestyle and medical interventions both positively and negatively affect patients? aspirations, choices and therefore well-being. They will be able to do this through the development of communicative competencies to respond to citizens? healthcare needs in challenging environments ? these include active listening, empathy, interpretative skills and critical reflection. At an organisational level, participants will have a better understanding of differing roles, motivations and mindsets across the institution or system. Thereby communication within and across groups will be improved, leading to more collaborative decision-making.

Spiral learning framework

Categorical thinking
Pre-training module 0Story reading/collecting
Module 1Mindset orientation and reflection
Module 2Content based story interpretation
Module 3Structure based story interpretation
Module 4Integrated story interpretation
Module 5Practice-based skills
Cognizant thinking

Module descriptions and learning outcomes

The spiral learning framework is designed to take trainees from categorial to cognizant thinking. It does this through the series of modules starting with module 0, which is the foundation module and then an additional number of modules as chosen from the available training combinations.

Module 0

Story reading/collecting

Learning outcome

Increased understanding of stories and their value in healthcare.

This first module is foundational to the training. It orients trainees to the importance of stories in healthcare, introducing what we mean by a story and how to collect and work with stories in healthcare training. The module introduces trainees to the key concepts and ideas in story-based learning.

Module 1

Mindset orientation and reflection

Learning outcome

Increased awareness of strengths and challenges of professional practice in relation to person-centred healthcare.

This module introduces trainees to the concept of mindset the lens through which we habitually see and respond to the world. Person-centred healthcare is also introduced as the key concern of the training. The module draws on reflective learning to help trainees consider their particular mindset in relation to the benefits and challenges of person-centred healthcare.

Module 2

Content based story interpretation

Learning outcome

Increased understanding of citizens? desires, increased communicative and interpretative competencies.

This module looks at the content of stories - what are people communicating in their stories? How can we better listen for this content and interpret it when we might have limited time and specific pressures in our professional roles? The module provides a range of exercises that draw out skills and attributes which support professionals to interpret the content of patients' stories.

Module 3

Structure based story interpretation

Learning outcome

Increased understanding of how to understand citizens' desires, increased communicative and interpretative competencies.

This module focuses on the structure of stories - what they might be communicating but not necessarily in words. This module gives trainees skills in how to interpret the structure of stories through considering metaphors, contradictions and plotlines. These skills support healthcare providers to interpret the emotional and imaginative subtexts of their patients' stories.

Module 4

Integrated story interpretation

Learning outcome

Increased awareness of different professional roles and responsibilities and multiple ways of interpreting citizens? stories, increased communicative competencies in relation to these .

This module looks at stories of different people, roles and organisations coming together in the care of an individual. Patients engage with many different healthcare professionals - professionals work with other professionals in different roles. This can create synergies and/or tensions. The module is focused on the importance of learning across these stories, at the institutional level and the importance of dialogue in negotiating these.

Module 5

Practice based skills

Learning outcome

Understanding of how to embed skills developed in professional contexts.

The final module is focused on embedding the skills developed throughout the training in trainees' own professional contexts. The module returns to mindset, asking trainees to re-evaluate their own mindset in light of what they have learned about stories and to identify how this learning can support more collaborative conversations and decision-making in practice.