The view from here
Is patient satisfaction affected by a student? Chantelle Wiseman, Intensive Therapy Unit, Anaesthetic Department, Nevill Hall Hospital, Abergavenny, UK
Discussions the doctor and student have allow the patient to witness the rationale behind diagnosis and treatment
s a medical student, I always wondered whether my presence in a clinic affected the consultation. I felt this most keenly when completing my general practitioner (GP) placement, as here I participated in clinics rather than remain an observer. By taking an active role in the consultation, was I affecting the patients’ satisfaction compared with when they had seen their GP as usual? There appear to be both advantages and disadvantages to medical students participating in consultations: studies investigating patients’ attitudes towards students in primary care
have demonstrated a range of feelings from neutral to positive.1–5 An international review has shown that patients like consultations with medical students because they are usually longer, they get the opinion of the student and the doctor, and the examination and patient education are completed more thoroughly.4 In addition, I think that the additional role of the doctor as a teacher will lend them a higher status, and therefore increased respect and trust by the patient. Having a student present may make the patient feel that the doctor won’t be able to cut corners, as they’ll need to consult correctly
to demonstrate good practice. In addition, the discussions the doctor and student have allow the patient to witness the rationale behind their diagnosis and treatment, even if they don’t understand the complexities. Finally, the patients may also enjoy the altruism of being able to help medical students in their studies,3,4 and may appreciate being ‘interesting’ enough to be used as teaching examples. However, patients feel less comfortable having a student perform intimate examinations, and in presenting to them with emotional problems, in part
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because of a lack of rapport, which may stop them revealing the real reason for their attendance at the clinic.2–4 They may feel that the doctor will spend too much time teaching, rather than giving them their full attention. In addition, I think that the inexperience of the student doctor, and the confusion and lack of trust the patient will feel if the student and doctor have conflicting decisions, could lead to a decreased level of satisfaction with the consultation. Sometimes patients feel that they cannot refuse having a student present.3 Research has also shown that patients are happier to accommodate medical students if they know why they are there and what to expect from them.5 Having the receptionists inform
all patients when booking the appointment that there will be a trainee doctor present, and allowing them to opt out if they are uncomfortable, would be one way to improve satisfaction with student clinics. Medical students need to be allowed to observe and participate in clinical consultations to allow them to develop the skills and attitudes to be an effective clinician. From my literature review and reflections I learned that this does not cause significant problems with patient satisfaction. This allowed me as a student to feel more comfortable participating in consultations, although I introduced myself from then on as a ‘student doctor’ so that all of the patients clearly knew what role I was undertaking.
Cooke F, Galasko G, Ramrakha V, Richards D, Rose A, Watkins J. Medical students in general practice: how do patients feel? Br J Gen Pract 1996;46:361–362.
O’Flynn N, Spencer J, Jones R. Does teaching during a general practice consultation affect patient care? Br J Gen Pract 1999;49:7–9.
Price R, Spencer J, Walker J. Does the presence of medical students affect quality in general practice consultations? Med Educ 2008;42:374–381.
Mol SSL, Peelen JH, Kuyvenhoven MM. Patients’ views on student participation in general practice consultations: a comprehensive review. Med Teach 2011;33e:397–400.
Benson J, Quince T, Hibble A, Fanshawe T, Emery J. Impact on patients of expanded, general practice based, student teaching: observational and qualitative study. BMJ 2005;331:89.
Patients are happier to accommodate medical students if they know why they are there
Corresponding author’s contact details: Dr Chantelle Wiseman, Intensive Care Unit, Anaesthetics Department, Nevill Hall Hospital, Abergavenny, NP7 7EG, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: None required. doi: 10.1111/tct.12078
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