Medical students in the emergency department: how do patients view participation in clinical teaching?
ABSTRACT A survey was carried out in the Emergency Department (ED) of a single urban Irish teaching hospital to determine patients' acceptability towards medical students and their attitudes towards participating in clinical teaching. We analysed 145 patient replies and found 45 (31%) patients with previous ED medical student contact. Amongst these, 23/45 (51%) did not have verbal consent before being seen, 8/45 (18%) experienced pressure to participate but overall 35/45 (78%) felt their experience was a positive one. When patients who did not have previous contact with medical students were included in the analysis, receptiveness to student examination and procedures remained high [119 (82%) and 102 (70%) respectively] despite almost none of the patients recalled reading information about participating in medical teaching. Up to 52% patients would vary their consent depending on the severity of their clinical complaint but the majority, 104 (81%) patients were satisfied that involving medical students would not alter their clinical care.
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ABSTRACT: To determine the proportion of patients in a teaching hospital ED who are available to medical students; identify barriers to student access to patients; and determine whether patients are more likely to be accessible if the term student doctor is used rather than medical student. Repeated cross-sectional study of the ED of a tertiary teaching hospital. Interviews were attempted with all patients in the ED during six 4 h periods. Outcome measures included: number of patients present and accessible to students; present but inaccessible, absent or unfit to be seen for clinical reasons; number of patients consenting to history, physical examination and certain procedures; and difference in patient consent between the terms 'medical student' and 'student doctor'. Overall, 180 of 450 (40.0%) patients completed the interview, 72 (16.0%) were able to be observed only, and 198 (44.0%) were not suitable for interview or observation. The common reasons for patient unsuitability were: physically not available (60%), being assessed by a health professional or undergoing a procedure (13.0%) altered mental status (7.4%), unstable or terminally ill (5.2%); refusal to participate in the study (4.8%), or dangerous or under arrest (4.1%). No significant differences were found in patient willingness to undergo clinical skills from 'student doctors' compared with 'medical students'. A minimum 40% of patients in a tertiary ED are accessible for student learning, with high proportions of patients accepting of students practising supervised history-taking, physical examination, and most less-invasive procedural skills.Emergency medicine Australasia: EMA 06/2011; 23(3):364-71. DOI:10.1111/j.1742-6723.2011.01414.x · 1.22 Impact Factor
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ABSTRACT: 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. 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. 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. 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.Annals of the Academy of Medicine, Singapore 07/2010; 39(7):555-10. · 1.22 Impact Factor
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ABSTRACT: Digital rectal examination (DRE) is an essential skill which all newly qualified doctors should have. There is evidence in the literature that junior doctors lack this important examination technique. The aim of our study was to determine, with the help of a questionnaire, the abilities of foundation year 1 (FY1) doctors to perform DRE. A questionnaire was developed and sent to newly qualified FY1 doctors qualified in two universities (Nottingham and Sheffield) within the first 4 weeks of starting as a FY1 doctor. Ninety (75%) out of 120 questionnaires were completed. Most FY1 doctors had very little experience in performing DRE on a patient, and 68 (76%) had performed less than 10 procedures prior to qualification. Very few of these doctors had their clinical findings on DRE checked by a senior doctor (n = 7, 8%). Comparing DRE with other forms of examination, newly qualified doctors were most confident at groin hernia examination followed by testicular examination. They were least confident with vaginal examination and DRE (ANOVA P = 0.0082). Digital rectal examination is frequently performed by the most inexperienced doctor and may not be verified by a more senior colleague. More training and supervision of junior doctors are required both prior to qualification and during the early stages of their medical career.Colorectal Disease 11/2009; 13(3):337-40. DOI:10.1111/j.1463-1318.2009.02116.x · 2.02 Impact Factor