The effect of patients' race on their attitudes toward medical students' participation in ambulatory care visits

Impact of students in non-teaching hospitals

BACKGROUND

The placement of medical students in non-teaching hospitals is the norm worldwide. The suggestion that teaching standards are inferior in non-teaching hospitals has been studied and refuted. This study explores this from a different perspective: the impact of medical student presence on the teachers, hospital environment and patient care at King Saud Medical City, as assessed by clinical supervisors.

METHODS

A questionnaire was distributed to clinical supervisors on the internal medical rotation at King Saud Medical City, College of Medicine, Al Imam Muhammed Ibn Saud Islamic University, Saudi Arabia. The view of supervisors on the impact of medical students on clinical supervisors themselves, the hospital environment and patient care was elicited. This study explores… the impact of student presence on teachers, hospital environment and patient care RESULTS: Between 69 and 84 per cent of respondents believed medical students had a positive effect on their practice, including increased reflective practice, increased enthusiasm and prompts to review basic medical knowledge. Accordingly, 85 per cent of clinical supervisors believed that their continuing medical education had been improved. A majority of respondents reported a positive impact on the hospital environment, with 66 per cent believing patient care to have improved.

DISCUSSION

Numerous studies have confirmed the standard of education in non-teaching hospitals to be as good as or better than in the corresponding teaching hospitals. It has also been shown that non-teaching hospitals fulfill the needs of medical students. It is suggested that this study demonstrates a positive impact of medical students on the clinical teachers in a non-teaching hospital in Saudi Arabia, with a significant proportion of teachers believing the hospital environment and quality of care to be improved by their presence.

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.

Obstetric and gynecologic patients' attitudes and perceptions toward medical students in saudi arabia

OBJECTIVE

To identify patients' attitudes, preferences and comfort levels regarding the presence and involvement of medical students during consultations and examinations.

METHODS

A cross-sectional descriptive study was conducted from September 2011 to December 2011 at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Participants were randomly selected from the outpatient and inpatient clinics at the Department of Obstetrics and Gynecology and the Emergency Department, provided they were admitted for obstetric or gynecology-related conditions. Data were collected using a structured questionnaire, and data analysis was performed using the Statistical Package for Social Sciences.

RESULTS

Of the 327 patients who were recruited, 272 (83%) were elective patients who were seen at the outpatient and inpatient clinics of the Department of Obstetrics and Gynecology (group I). The other 55 (16.8%) were seen at the Emergency Department or the Labor and Delivery Ward (group II). One hundred seventy-nine participants (160 [58.8%] in group I and 19 [34.5%] in group II) reported positive attitudes about the presence of female medical students during consultations. Fewer participants (115 [42.3%] were in group I and 17 [30.9%] in group II) reported positive attitudes regarding the presence of male medical students during consultations (p=0.095). The gender of the medical student was the primary factor that influenced patients' decision to accept or decline medical student involvement. No significant associations were observed between patients' attitudes and perceptions toward medical students and the patients' age, educational level, nationality or the gender of the consultant.

CONCLUSION

Obstetrics and Gynecology patients are typically accepting of female medical student involvement during examinations. Student gender is the primary factor that influences patient attitudes regarding student involvement during physical examinations.

Medical students' perceptions of the physician's role in not allowing them to perform gynecological examinations

PURPOSE

To determine how often medical students are not allowed to perform gynecological examinations during their obstetrics-gynecology clerkship, identify the barriers to participation related to physicians and patients, explore the role of the supervisory physician in not allowing medical student involvement, and explore differences between male and female students' experiences.

METHOD

All medical students entering their obstetrics-gynecology clerkship at a medical school in the Netherlands between May and October 2011 were invited to participate in this study's questionnaire, which asked them to report the number of gynecological examinations they were allowed and not allowed to perform during their clerkship. Eighteen questionnaire respondents participated in three focus groups.

RESULTS

Of the 139 medical students invited, 76 (55%) completed the questionnaire. Students reported a total of 2,196 instances in which they were not allowed to participate in the examination; 89% (n = 1,956) were related to the supervisory physician. Qualitative data from the focus group interviews showed that female supervisory physicians prioritized patients' autonomy above students' learning needs. Furthermore, female students were less assertive than male students in asking the supervisory physician for permission to participate.

CONCLUSIONS

The physician's role in not allowing student involvement is substantial and results in fewer opportunities for students to perform gynecological examinations. For students to develop the necessary gynecological exam skills during their clerkship, medical educators need to improve the learning environment.

Patient perceptions of having 1st- and 2nd-year medical students involved in their care

BACKGROUND

Medical student education has shifted to earlier clinical experiences and increased use of ambulatory settings. Little is known about patient perceptions of having 1st- and 2nd-year medical students involved in their care.

PURPOSES

The purpose of this article is to study patient perceptions of having 1st- and 2nd-year medical students involved in their care in an ambulatory setting.

METHODS

In 2011 we surveyed 314 patients seen in 2 primary care clinics who saw 1st- or 2nd-year medical students. The survey included questions regarding patient visit satisfaction and perception of overall quality of the visit, adequacy of visit time, benefit of having a student involved in their care, and willingness to see a student in clinic again. Comparisons were made for patients who saw a student and a preceptor (n = 201) and patients who saw only the preceptor (n = 113).

RESULTS

Overall visit satisfaction was very high for patients who saw students (83% very satisfied) and patients who saw only the preceptor (91% very satisfied). More than 95% of patients were satisfied with the visit time, and all patients rated the overall quality of their visit as good or excellent. Eighty-five percent of patients would want to see a student again or had no preference. Forty-three percent of patients felt the presence of a student added value to their visit. White patients were more likely than non-White patients to be very satisfied with their visit and rated the overall quality of the visit as excellent. There were no differences based on student gender or year of training.

CONCLUSIONS

Our results suggest that 1st- and 2nd-year students can be successfully integrated into clinical settings while maintaining patient satisfaction and perceived value of the care they receive.

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

When patients decline medical student participation: the preceptors' perspective

Patients' receptivity towards medical student participation has been examined predominantly from the patient and/or the medical student perspective. Few studies have investigated the preceptor's perspective. The study examined preceptors' experience with patients declining medical student participation in clinical care and identified preceptor-related factors associated with this experience. Preceptors (n = 42) were recruited from a Family Medicine educational presentation and completed a survey assessing encounters with patients declining medical student participation, methods for obtaining patient consent, and self-rated clinical education skills. Forty-eight percent and 62% of preceptors have "sometimes" or "often" had patients decline student involvement due to student's status and in the context of a gynecological/urological exam, respectively. Fifty-eight percent "never" or "seldom" obtain patient consent with the student outside the exam room, while 46% "often" or "always" have the student directly inform patients about his/her involvement. Being a faculty preceptor (versus resident preceptor) (r = 0.463, p = 0.026) and feeling uncomfortable talking to patients about students performing the exam (r = -0.482, p = 0.020) were associated with patients declining student participation for a genital exam. Findings indicate that preceptors encounter patients declining medical student involvement in general and sensitive exam scenarios. In addition, patients are more likely to decline student participation when preceptors are faculty members and less comfortable discussing student involvement.

Patient attitudes toward medical students in an outpatient colorectal surgery clinic

PURPOSE

Patients with colorectal diseases may be reluctant to have medical students present during their outpatient clinic visit, especially when significant disrobing and embarrassing examinations are performed. This study examines patient attitudes in this regard.

METHODS

One hundred consecutive patients completed a questionnaire after the conclusion of their office visit. Patient age, gender, race, diagnosis, level of disease, socioeconomic status, and education level were recorded as well as attitudes toward the presence of students in the examination room. Responses were analyzed by using two-sample Z tests or chi-squared tests for comparison of proportions among groups. The pooled-variance t-test was used to compare the difference of means when appropriate.

RESULTS

Overall, 81 percent of patients accepted students' presence. Females were less likely than males (77 vs. 86 percent; P = 0.03) and blacks less likely than whites (61 vs. 88 percent; P = 0.004) to accept students. Higher compliance was demonstrated in patients with greater perceived severity of disease (P = 0.03). We found no significant correlation between patient level of education or income and their comfort level with respect to teaching in the examination room. However, racial differences were seen in this category (P = 0.01). Females were more likely to prefer the same gender student, but this was not statistically significant.

CONCLUSIONS

Students are generally accepted in outpatient colorectal clinics (81 percent). Reasons for acceptance of students included being able to contribute to the teaching of future doctors. Reasons for refusal included perceived increased length of the office visit and patient privacy. We noticed significant differences in compliance by gender, race, and severity of disease, but not age, patient level of income, or education.

Patients' attitudes towards the presence of medical students during consultations

This study analyses the attitudes of patients towards the presence of medical students during consultations. It was conducted in a very culturally and ethnically diverse part of London. The study aimed to investigate the factors, particularly ethnicity, which influence patients' attitudes towards medical students. A total of 422 patients participated in the study, which was conducted in general practice and hospital outpatient waiting areas in the London Boroughs of Tower Hamlets and Hackney. In general, the results demonstrate that patients are positive towards medical student participation during consultations. In particular, older patients, patients born in the UK and patients with prior experience of medical students seem to be particularly favourable towards students. However, compared with the White-British population, the non-White-British population appears to be more negative towards medical student participation. This study highlights the need for patient education regarding the importance, for the training of future doctors, of medical student involvement in consultations.

Assessing quality and costs of education in the ambulatory setting: a review of the literature

PURPOSE

Time-pressured interactions with little direct observation or feedback characterize teaching in ambulatory settings. The authors report findings from the literature on teaching and learning in the ambulatory setting and propose opportunities for further research that addresses these barriers.

METHOD

The authors searched 1995-1999 databases for all empirical studies that focused on research conducted in ambulatory settings. Publications were reviewed for evidence of inclusion criteria. Findings were sorted into categories previously described for defining and evaluating quality of ambulatory care educational programs.

RESULTS

Most studies were conducted in departments of internal medicine (40%), focused on medical students (43%), and took place in a single program (77%), making generalizations difficult. Students and residents are learning in ambulatory environments, and the types of patients they encounter are likely to prepare them for practice. Patient care outcomes have emerged as a measure of learning. Teachers may be the single most important factor, yet they lack self-confidence as teachers. Community-based preceptors teach because of enjoyment of teaching and the opportunity to stay current. However, none of the studies addressed the impact of the Medicare documentation requirements on satisfaction with teaching. Teaching settings cost about one third more than non-teaching settings to operate.

CONCLUSION

This review identifies many gaps in our knowledge of effective clinical teaching practices, and of learning environments in which that teaching takes place. The predominance of single-institution studies limits generalizability of current findings. A prioritized research agenda should be established and funded, focusing on improving the efficiency and effectiveness of teaching and learning in ambulatory settings.

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.

Attitudes of patients towards the involvement of medical students in their intrapartum obstetric care

Data investigating patients' attitudes towards and expectations of medical students in an obstetric setting are limited. We have examined the attitudes of pregnant women towards the involvement of medical students in their intrapartum care. Ethics committee approval and informed patient consent were obtained. A survey of 203 antenatal patients was performed. Chi-squared tests were applied to discrete and Student's t-test to continuous data. Only 62% of antenatal patients were prepared to accept medical student participation in their intrapartum care, although 84% agreed that participation was important for student education. Of note, only 43% of patients were prepared to have a male medical student involved in their care. Only 54% of patients correctly identified that the description medical student referred to a doctor in training, others defining it to include nurses, midwives and other hospital staff in training. If increasing numbers of patients decline medical student participation in their intrapartum care, then alternative teaching strategies may be required. Medical educators need to ensure that patients are aware of the role of medical students in order to gain informed consent from patients for student participation in their care.