The effect of medical student teaching on patient satisfaction in a managed care setting

The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability?

Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores at academic and private health care centers to assess the impact of trainees on patient satisfaction. From 2013 to 2017, 3454 HCAHPS surveys were collected at the investigating institution from patients who underwent primary total hip and total knee arthroplasty. Surveys were categorized based on the inpatient practice setting-academic hospitals included orthopedic residents and medical students who were involved in perioperative care, whereas private settings did not have trainee involvement. Patient demographics, including age, body mass index, sex, and American Society of Anesthesiologists score, were retrospectively collected. A total of 2454 HCAHPS surveys from 2 academic hospitals and 1000 surveys from a private hospital were collected. Patients at the academic hospitals were more likely to report that symptoms to look out for were clearly explained (odds ratio, 1.882; P=.001), whereas patients from the private hospital were more likely to report that the hospital was always quiet at night (odds ratio, 1.271; P=.005). The overall satisfaction score was not significantly different between the academic and private settings (78.9 vs 80.2, respectively; P=.111). The overall hospital satisfaction score for patients undergoing primary total hip and knee arthroplasty was not significantly different between private and academic medical facilities. Thus, this study supports the idea that training future orthopedic surgeons will not negatively impact patient satisfaction scores in a way that affects reimbursement. [Orthopedics. 2022;45(5):276-280.].

Challenges Facing Undergraduate Medical Education in Ambulatory Care Clinics at Tertiary Care Hospitals

Background: Medical education has been rapidly growing and transforming due to the enormous evolution of medicine. There have been many proficient ways to learn in medicine, but academic lectures, attending wards, and ambulatory care clinics (ACC) remain the three main ways of gaining clinical knowledge and experience for medical students. Over the past decade, there has been a dramatic shift in care by focusing on ambulatory care rather than inpatient settings, which provides a golden opportunity to reinforce medical education. Purpose: Most of the published studies that have focused on the teaching barriers in ACC were descriptive rather than analytic studies. Herein, we aim to detect and determine the barriers to teaching in ACC settings using qualitative analysis. Methods: This is a cross-sectional, observational study, involving medical students in their clerkship years (i.e., fourth and fifth) from two different medical colleges in Riyadh, Saudi Arabia. Faculty who are involved in undergraduate medical education in both colleges were also included. Main Results: A total of 387 medical students studying at the two universities were enrolled in the study. Most of the participants preferred attending outpatient clinics with consultants (44.2%) and the majority preferred attending internal medicine (IM) and IM subspecialties clinics (40.4%). Regarding the challenges, students believe the top three barriers are related to: faculty (39%), environment (34.8%), and patients (14.8%). Faculty on the other hand see that the top three barriers are related to environment (55.6%), patients (24.4%), and faculty (20%). Conclusion: Undergraduate medical education in outpatient settings has many challenges. In our study, the most significant challenges were COVID-19-related restrictions, patient refusal, and insufficient time for teaching. Future studies are needed to investigate these barriers and explore potential solutions that can decrease their burden on undergraduate medical education.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review

BACKGROUND

Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures.

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis.

RESULTS

The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance.

CONCLUSION

Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

Patient Satisfaction With Medical Student Participation in a Longitudinal Integrated Clerkship: A Controlled Trial

PURPOSE

To determine whether longitudinal student involvement improves patient satisfaction with care.

METHOD

The authors conducted a satisfaction survey of patients followed by 10 University of Minnesota Medical School students enrolled in 2016-2017 in the Veterans Affairs Longitudinal Undergraduate Medical Education (VALUE) program, a longitudinal integrated clerkship at the Minneapolis Veterans Health Care System. Students were embedded in an ambulatory practice with primary preceptors who assigned students a panel of 14 to 32 patients to follow longitudinally in inpatient and outpatient settings. Control patients, matched on disease severity, were chosen from the preceptor's panel. Two to five months after the students completed the VALUE program, the authors conducted a phone survey of the VALUE and control patients using a validated, customized questionnaire.

RESULTS

Results are reported from 97 VALUE patients (63% response rate) and 72 controls (47% response rate) who had similar baseline characteristics. Compared with control patients, VALUE patients reported greater satisfaction with explanations provided by their health care provider, their provider's knowledge of their personal history, and their provider's looking out for their best interests (P < .05). Patients in the VALUE panel selected the top category more often than control patients for overall satisfaction with their health care (65% vs 43%, P < .05).

CONCLUSIONS

The results of this controlled trial demonstrate that VALUE student longitudinal participation in patient care improves patient satisfaction and patient-perceived quality of health care for VALUE patients compared with controls matched by primary care provider and disease severity. These findings may have implications outside the Veterans Administration population.

Level of satisfaction of users of a teaching hospital: the influence of the presence of students

OBJECTIVE

To evaluate the level of satisfaction of inpatients in a teaching hospital regarding the quality of the hospital service by comparing term and non-term times.

METHOD

Cross-sectional study carried out in three inpatient units with users from 18 to 80 years old who stayed in the hospital for at least 72 hours. An instrument for sociodemographic characterization and the SERVQUAL scale were applied to measure the level of satisfaction. Data collection occurred in two periods: term and non-term times.

RESULTS

Three hundred and five users of the service of both genders, with an average age of 46.2 years, were interviewed. Concerning the dimensions that make up the SERVQUAL scale, empathy was mentioned as the one with which the users attended to during term time expressed the greatest dissatisfaction (p=0.01). Regarding the service dimension, the level of satisfaction of the users was higher during term time (p=0.01). Tangibles, reliability, and assurance did not show differences when comparing the two examined periods.

CONCLUSION

The users identified higher empathy and better service during term time, but similar perceptions were not reported for assurance and reliability.

Patient feedback on medical students in tertiary health care: are medical students accepted in clinical practice?

BACKGROUND

Clinical teaching is central in the training of medical students. Although medical studies without practice are hard to imagine nowadays, for most patients this type of learning is still difficult to understand and not always acceptable.

MATERIALS AND METHODS

A prospective anonymous survey of 150 participants was carried out. Participants were patients at the Surgery Department of the Kauno Klinikos Hospital of the Lithuanian University of Health Sciences. The questionnaire comprised 12 questions: the first two on the patients' personal information and the rest about the patients' opinion about medical students. Statistical analysis software IBM SPSS Statistics 23.0 was used for statistical data analysis. A statistically significant difference was observed when p < 0.05.

RESULTS

Seventy-eight per cent of patients would allow medical students to be present during their surgery; 78.7% would permit medical students help the anaesthetic team with procedures; 79% responded that students were not introduced, and 21.3% stated that they were informed about students' involvement for learning purposes. The majority of the respondents (62%) answered that the main advantage was additional practical skills. Talking about disadvantages, 25% of the respondents thought that students were not professional enough, 6% were worried about an overcrowded operating theatre, yet the majority of patients (69%) did not worry about this.

CONCLUSIONS

The majority of patients would agree with the involvement of medical students in their surgical operations and induction of anaesthesia. The patients pointed out that the general reason for their concern over surgical operations was that the students were not professional enough and did not have required skills. Most patients thought that involving students in their surgical operations did not have negative influence on surgery quality.

Patient Perception of Medical Learners and Medical Education during Clinical Consultation at a Family Medicine Residency

INTRODUCTION

Experience in treating patients under supervision of faculty is an important factor in medical education at all levels. However, unpleasant patient experiences with a medical learner during clinical consultation can damage the relationship between the medical learner, physician supervisor, and patient. A goal of this study was to examine patient experiences and preferences regarding medical learners during clinical consultation at a family medicine residency clinic. Another goal was to determine factors relating to patients' experiences and preferences regarding medical learners.

METHODS

This cross-sectional study relied on patients completing a survey designed from extant questionnaires to measure patients' experiences and preferences relating to interactions with medical learners at a family medicine clinic. Data were collected from 216 patients between December 2016 and August 2017. We correlated patients' feelings, overall experiences with medical learners and the importance of medical education.

RESULTS

There was a 93% participation rate. The patients rated their overall experiences with medical learners as 3.8 on a 5-point scale, suggesting positive experiences. Eighty-eight percent prefer not more than three medical learners to be involved in their care during clinical consultation. Patients' overall experiences with medical learners participating in medical care correlated with their preferences regarding medical learners' involvement in their treatment (r[209] = .524; p = 0.01). Patients' perception of medical learners participating in medical care correlated with the importance of medical education (r[209] = .878; p = 0.01).

CONCLUSIONS

The results showed that most patients have positive experiences with medical learners and are generally in favor of medical education.

Students with an autonomous role in hospital care - patients perceptions

BACKGROUND

There have been calls to enhance clinical education by strengthening supported active participation (SAP) of medical students in patient care. This study examines perceived quality of care when final-year medical students are integrated in hospital ward teams with an autonomous relationship toward their patients.

METHODS

We established three clinical education wards (CEWs) where final-year medical students were acting as "physician under supervision". A questionnaire-based mixed-method study of discharged patients was completed in 2009-15 using the Picker Inpatient Questionnaire complemented by specific questions on the impact of SAP. Results were compared with matched pairs of the same clinical specialty from the same hospital (CG1) and from nationwide hospitals (CG2). Patients free-text feedback about their hospital stay was qualitatively evaluated.

RESULTS

Of 1136 patients surveyed, 528 (46.2%) returned the questionnaire. The CEWs were highly recommended, with good overall quality of care and patient-physician/student-interaction, all being significantly (p < 0.001) higher for the CEW group while experienced medical treatment success was similar. Patient-centeredness of students was appreciated by patients as a support to a deeper understanding of their condition and treatment.

CONCLUSION

Our study indicates that SAP of final-year medical students is appreciated by patients with high overall quality of care and patient-centeredness.

A co-created intervention with care home residents and university students following a service-learning methodology to reduce sedentary behaviour: The GET READY project protocol

BACKGROUND

There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents' complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate service-learning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers.

METHODS

Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

Patients' Perceptions Towards the Participation of Medical Students in their Care

OBJECTIVES

Patient interaction is a vital part of healthcare training. This study aimed to investigate patients' perceptions of the participation of medical students in their care.

METHODS

This descriptive cross-sectional study was conducted between October 2014 and March 2015 among 430 patients admitted to the medical and surgical wards at the King Abdulaziz Medical City, Riyadh, Saudi Arabia. An Arabic questionnaire was designed to assess the demographic characteristics of the patients and their perceptions of students' participation in their medical care.

RESULTS

A total of 416 patients completed the survey (response rate: 97%). Overall, 407 patients (98%) acknowledged the educational benefit of involving medical students in their care. A total of 368 patients (88%) had no objection to a medical student being involved in their care. Of these, 98% were willing to be asked about their medical history by medical students, 89% would permit physical examinations by medical students and 39% preferred that the gender of the medical student match their own. Education level (P <0.003), a positive prior experience with a medical student (P <0.001) and perception of the medical students' attitudes (P <0.001) had a significant effect on patients' acceptance of medical students participating in their care.

CONCLUSION

In general, the patients had a positive perception of medical students, with most patients acknowledging the educational benefit of student participation in patient care. As patients' perceptions of students' professionalism, confidence and respect for privacy were significantly related to acceptance of care, education on these aspects should be a priority in medical curricula.

Is three a crowd? Impact of the presence of a medical student in the general practice consultation

OBJECTIVES

To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student.

METHODS

An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times.

RESULTS

Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p = 0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p = 0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p = 0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p < 0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20 minutes consultation; p = 0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p = 0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning.

CONCLUSIONS

The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.

Patients' Attitudes Toward Medical Student Participation Across Specialties: A Systematic Review

Phenomenon: Medical students commonly participate in patient care in a variety of different settings. However, a systematic review of patients' attitudes toward medical student participation across specialties has not been performed.

APPROACH

The authors searched 7 databases (CINAHL, Cochrane Library, ERIC, MEDLINE, PsycINFO, Scopus, and Web of Science) between January 1, 1999, and August 5, 2014. Two authors independently screened the results and selected articles that were written in English, were published in a peer-reviewed journal, and used a structured or semistructured survey or interview to determine patients' attitudes toward medical student participation in their care. Study quality was assessed using the Medical Education Research Study Quality Instrument.

FINDINGS

Fifty-nine studies were included. Average study quality was low. Sixty-one unique evaluation instruments were used, and 34 instruments (56%) lacked validity data. Patient satisfaction was not significantly affected by medical student participation. However, patients' acceptance of medical student participation varied widely between studies and depended on the type of participation. The most common reason for acceptance was a desire to contribute to the education of others, and the most common reason for refusal was concerns about privacy. Minorities were more likely to refuse medical student participation. Patients preferred to be informed before medical students participated in their care. Insights: Patient satisfaction is not significantly affected by medical student participation. However, patient satisfaction may be a poor surrogate marker of patients' acceptance of medical students. Future research should employ validated evaluation instruments to further explore patients' attitudes toward medical student participation.

The transition to a teaching hospital: patient satisfaction before and after the introduction of medical students

BACKGROUND

Several studies have explored the effect of the presence of medical students on patient satisfaction. However, nearly all of these studies took place in hospitals where medical students had been involved in patient care for many years. Less is known about patients' perceptions of care in a hospital moving toward becoming a teaching facility with undergraduate students. No research has explored patient satisfaction before and after the introduction of medical students.

OBJECTIVE

To assess patient satisfaction as an indicator of quality of care (QoC) from the patients' perspective, before and after the presence of medical students in a general hospital setting.

METHODS

This observational, cross-sectional study was conducted at Hospital Universitario-Fundación Santa Fe de Bogotá (HU-FSFB) in Bogotá, Colombia. The study had two phases. In 2006, prior to HU-FSBF becoming a teaching hospital, 385 subjects were asked to fill out a closed-question questionnaire addressing patients' satisfaction and perception of QoC provided by attending physicians. During the second period in 2009, 372 patients answered the same questionnaire when medical students were involved in their care.

RESULTS

Patients' perceptions of QoC provided by attending physicians improved in five aspects when medical students were present: friendliness (p = 0.003), competence providing medical care (p = 0.049), quality of information provided (p = 0.025), amount of time spent with the patient (p < 0.001) and availability to personally provide care (p < 0.001). Overall patient satisfaction also significantly increased (p < 0.001).

CONCLUSIONS

The presence of medical students does not negatively affect patients' perceptions of QoC, on the contrary, these results provide evidence of improved patient satisfaction in several aspects of care when medical students were involved. The relevance of this study lies in its unique way of comparing patient satisfaction before and after the introduction of medical students. This setting helps elucidate the real effect of the presence of medical students on patient satisfaction.

Parent assessment of medical student's skills in ambulatory pediatrics

BACKGROUND

Partnership with parents is a vital part of pediatric medical education, yet few studies have examined parent attitudes towards learners in pediatric settings.

METHODS

Questionnaires were used to determine parent and student assessment of professional and clinical skills (primary outcome) and parent attitudes towards 3rd year medical students (secondary outcome) at the University of Alberta. Chi Square, Kendall's Tau and Kappa coefficients were calculated to compare parent and student responses in 8 areas: communication, respect, knowledge, listening, history taking, physical examination, supervision, and overall satisfaction.

RESULTS

Overall satisfaction with medical student involvement by parents was high: 56.7% of all parents ranked the encounter as 'excellent'. Areas of lesser satisfaction included physician supervision of students. Compared to the parent assessment, students tended to underrate many of their skills, including communication, history taking and physical exam. There was no relationship between parent demographics and their attitude to rating any of the students' skills.

CONCLUSIONS

Parents were satisfied with medical student involvement in the care of their children. Areas identified for improvement included increased supervision of students in both history taking and physical examination. This is one of the largest studies examining parent attitudes towards pediatric students. The results may enhance undergraduate curriculum development and teaching in pediatric ambulatory clinics and strengthen the ongoing partnership between the community and teaching clinics.

Willingness and attitudes of the general public towards the involvement of medical students in their healthcare

OBJECTIVES

To determine if patients allow medical students to perform less invasive procedures compared to more invasive procedures, and how this is related to patient demographics and previous experience with medical students.

METHODS

A cross-sectional survey was conducted in six areas of Birmingham, UK. All members of the general public over the age of 18 were eligible, excluding non-English speaking people and those with cognitive impairments. Respondents were asked to rank their willingness for medical students to perform history taking/examinations and clinical procedures of varying degrees of invasiveness.

RESULTS

We received a total of 293 responses. For both history taking/examinations and clinical procedures, people were more willing to allow medical students to perform less invasive procedures rather than more invasive procedures. White and older people were more willing to allow all history taking/examinations procedures; additionally, women were more willing to allow history taking. White, female, and older participants were more willing to allow blood pressure measurement; whilst older people and those with previous experience were more willing to allow venepuncture. No significant associations were found for intubation.

CONCLUSIONS

The public is less willing for medical students to perform more invasive procedures. This may severely limit opportunities to attain clinical competencies.

Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics

Introduction: Previous studies on patient acceptance of medical student teaching were from Western populations and in one setting only. However, there has been no prospective study comparing patient acceptability before and after an actual experience. We studied patient acceptability of medical student teaching in private and public family practices and public hospital specialist outpatient clinics in Singapore, and before and after an actual medical student teaching consultation. Materials and Methods: We conducted an anonymous cross-sectional survey from March through October 2007 of Singaporean or permanent resident patients attending 76 teaching private family practices, 9 teaching public family practices and 8 specialty clinics in a teaching public hospital. We used pre-consultation cross-sectional patient surveys in all three settings. For private family practice setting only, post-consultation patient survey was conducted after an actual experience with medical student presence. Results: Out of 5123 patients, 4142 participated in the cross-sectional survey (80.9%) and 1235 of 1519 patients in the prospective cohort study (81.3%). Eighty percent were comfortable with medical students present, 79% being interviewed and 60% being examined. Regarding being examined by medical students, parents of children were least comfortable while patients between 41 to 60 years were most comfortable (adjusted OR = 1.99 [1.55-2.57]). Females were less comfortable with medical student teaching than males. Chinese patients were the least comfortable about being interviewed or examined by medical students among the ethnic groups. Indians were most comfortable with being interviewed by medical students (adjusted OR = 1.38 [1.02-1.86]) but Malays were the most comfortable being examined by them (adjusted OR = 1.32 [1.07-1.62]). Family practice patients were more receptive to medical student teaching than the hospital’s specialist outpatients. Common barriers to patient acceptance were lack of assurance of patient privacy, dignity and confidentiality. Actual exposure to medical student teaching did not change levels of patient acceptance. Conclusions: Compared to similar studies from Western countries, Asian patients appear to be less receptive to medical student teaching than Western patients. Family practice settings offer medical students a more receptive learning environment. Key words: Ambulatory, Asian, Consultations, Family practice, Undergraduate

Informed Consent for Clinical EducationRandomized Study of Two Different Strategies at a Urology Surgery

OBJECTIVE

To study whether or not the provision of written information in advance might influence patients' inclination to participate in the clinical education of medical students at a urology surgery.

MATERIAL AND METHODS

A total of 169 outpatients referred to the urological surgery were randomly allocated either to receive information in advance or not, together with a notice of appointment that all patients receive by mail approximately 2 weeks prior to their visit. Patients in the experimental group received a written information letter in advance about medical education, whereas the control patients did not receive any written information, according to the standard procedure of the surgery. The patients were not told about the study until afterwards and neither the doctors/teachers nor the students knew in advance to which group a certain patient had been allocated. At the end of the visit the patients were asked to complete a questionnaire.

RESULTS

The randomization procedure resulted in 83 patients being informed in advance and 86 control patients not being informed. Forty-two patients completed the questionnaire: 19 in the experimental group and 23 in the control group. There was no difference between the groups with regard to reasons for dropping out.

CONCLUSIONS

This study indicates that the provision of information in advance does not negatively influence patients' inclination to participate in the clinical training of medical students.

A randomized, controlled trial of bedside versus conference-room case presentation in a pediatric intensive care unit

OBJECTIVES

Case presentation and teaching performed at the bedside are declining. Patients' preference between bedside case presentation and conference-room case presentation is divergent in the literature. Residents seem to prefer the conference room. The objective of this study was to ascertain whether there was a difference of satisfaction and comfort between bedside case presentation and conference-room case presentation for the parents of patients hospitalized in the PICU and for the residents in training in the PICU.

METHODS

Every child hospitalized in the PICU who had 2 consecutive morning rounds, performed in the presence of the same resident, attending pediatrician, and parent, was eligible for the study. The study began with the first patient's case presentation after admission in the PICU. Randomization was on the first case presentation: bedside or conference room. On the second day, the other type of case presentation was performed. After each round, the parents and the resident filled out a questionnaire.

RESULTS

Twenty-seven parents of 22 patients answered both questionnaires, and 21 questionnaires were answered by residents. Parents' satisfaction was significantly higher during bedside case presentation (96 vs 92, answers reported on a 100-mm linear scale), they preferred bedside case presentation (95 vs 15), and they were more comfortable attending bedside teaching (89 vs 19). There was no difference in the residents' satisfaction nor in their comfort giving the actual case presentation. Residents, on the other hand, were significantly more comfortable asking questions (84 vs 69) and being asked questions (85 vs 67) during conference-room case presentation. A total of 81% of the parents wished that the next case presentation would take place at the bedside.

CONCLUSIONS

This study demonstrates the feasibility of a clinical case presentation performed at the bedside in the PICU context that seems to satisfy parents without causing too much discomfort to residents. Thus, bedside case presentation could be a very good teaching strategy in university hospitals.

Brief report: Utilizing an audiotape for outpatient preceptor faculty development

BACKGROUND

Faculty development for busy and geographically dispersed ambulatory preceptors is a difficult task for course directors.

PURPOSE

A faculty development audiotape intended for playing in the preceptor's car was created. The feasibility of this form of faculty development was tested in this pilot study.

METHODS

A short audiotape, focusing on strategies for the provision of independence to students in the office setting, was made and distributed to all preceptors of students taking a fourth-year required clerkship in ambulatory medicine. Preceptor behavior was reported by students on postclerkship evaluations before and after tape distribution.

RESULTS

In the year before tape distribution, 21% of evaluations indicated a lack of independence on the part of the student, compared with 14% in the year following the intervention (P=.03). There was no regression of behavior among preceptors already providing independence. Among the preceptors initially identified as not following recommendations for student independence, the percentage of evaluations indicating a lack of independence went from 72% preintervention to 42% postintervention (P<.001).

CONCLUSIONS

A short audiotape is a novel form of faculty development, which was acceptable to preceptors and may influence teaching behavior in the desired manner.

The effect of giving information in advance on the clinical training of medical students

OBJECTIVE

To study whether or not giving written information in advance influences patients' willingness to participate in the clinical training of medical students.

SETTING

Dermatology surgery at a university hospital.

METHODS AND PARTICIPANTS

Prior to the visit, patients were randomly allocated either to receive a letter about medical education (the experiment group), or not to receive a letter (the control group).

MAIN OUTCOME MEASURE

The willingness of patients to participate in clinical training.

RESULTS

There was no difference between the 2 groups regarding their willingness to participate. Almost all patients perceived the provided information as good or rather good, but some patients, especially in the control group, did not feel free to refuse to participate.

CONCLUSION

The present written-information-in-advance strategy seems to prevent patients from feeling forced to participate, without having any negative influence on their inclination to participate.

How do precepting physicians select patients for teaching medical students in the ambulatory primary care setting?

OBJECTIVE

To study how clinical preceptors select patients for medical student teaching in ambulatory care and to explore key factors they consider in the selection process.

DESIGN

Qualitative analysis of transcribed interviews.

SETTING

Harvard Medical School, Boston, Mass.

PARTICIPANTS

Nineteen physicians (14 general internists and 5 general pediatricians) who serve as clinical preceptors.

MEASUREMENTS

Responses to in-depth open-ended interview regarding selection of patients for participation in medical student teaching.

MAIN RESULTS

Preceptors consider the competing needs of the patient, the student, and the practice the most important factors in selecting patients for medical student teaching. Three dominant themes emerged: time and efficiency, educational value, and the influence of teaching on the doctor-patient relationship. These physicians consciously attempt to select patients whose participation in medical student teaching maximizes the efficiency of the clinical practice and optimizes the students' educational experiences, while minimizing any potential for harming the relationship between preceptor and patient.

CONCLUSIONS

These findings may help validate the frustration preceptors frequently feel in their efforts to teach in the outpatient setting. Becoming more cognizant of the competing interests-the needs of the patient, the student, and the practice-may help physicians to select patients to enhance the educational experience without compromising efficiency or the doctor-patient relationship. For educators, this study suggests an opportunity for faculty development programs to assist the clinical preceptor both in selecting patients for medical student teaching and in finding ways to maximize the efficiency and educational quality of the outpatient teaching environment.

Teaching as therapy: cross sectional and qualitative evaluation of patients' experiences of undergraduate psychiatry teaching in the community

OBJECTIVE

To explore the impact of participating in undergraduate teaching in general practice for patients with common mental disorders.

DESIGN

Questionnaire survey and qualitative in-depth interviews.

SETTING

Community based undergraduate teaching programme for fourth year students at a London medical school doing a psychiatry attachment.

PARTICIPANTS

Questionnaire survey: all patients involved in the teaching programme over one academic year. In-depth interviews: 20 patients, 14 students, and 12 general practitioner tutors participating in the programme.

RESULTS

The questionnaire showed high levels of satisfaction with teaching encounters for participating patients, which were corroborated in the interviews. Many patients and general practitioners reported specific therapeutic benefits for patients from contact with students, including raised self esteem and empowerment; the development of a coherent "illness narrative"; new insights into their problems; and a deeper, more balanced, and understanding doctor-patient relationship. For a few patients the teaching caused some distress, which may relate to a lack of insight into their condition or deficits in students' interviewing skills.

CONCLUSIONS

Participation in teaching can have additional positive therapeutic outcomes for selected patients with common mental disorders, although a small minority report negative effects. Testing in a larger sample is needed to determine the characteristics of patients in these two subgroups and establish whether these effects persist.

Effect of student involvement on patient perceptions of ambulatory care visits: a randomized controlled trial

OBJECTIVE

To determine if patient satisfaction with ambulatory care visits differs when medical students participate in the visit.

DESIGN

Randomized controlled trial.

SETTING

Academic general internal medicine practice.

PARTICIPANTS

Outpatients randomly assigned to see an attending physician only (N = 66) or an attending physician plus medical student (N = 68).

MEASUREMENTS AND MAIN RESULTS

Patient perceptions of the office visit were determined by telephone survey. Overall office visit satisfaction was higher for the "attending physician only" group (61% vs 48% excellent), although this was not statistically significant (P =.16). There was no difference between the study groups for patient ratings of their physician overall (80% vs 85% excellent; P =.44). In subsidiary analyses, patients who rated their attending physician as "excellent" rated the overall office visit significantly higher in the "attending physician only" group (74% vs 55%; P =.04). Among patients in the "attending physician plus medical student" group, 40% indicated that medical student involvement "probably" or "definitely" did not improve their care, and 30% responded that they "probably" or "definitely" did not want to see a student at subsequent office visits.

CONCLUSIONS

Although our sample size was small, we found no significant decrement in patient ratings of office visit satisfaction from medical student involvement in a global satisfaction survey. However, a significant number of patients expressed discontent with student involvement in the visit when asked directly. Global assessment of patient satisfaction may lack sensitivity for detection of dissatisfaction. Future research in this area should employ more sensitive measures of patient satisfaction.