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Kolshus EM, Akinmoluwa S, Sloan D, MacSuibhne S, Kolshus EH. Patients' Attitudes Towards Medical Student Presence in Psychiatric Consultations. Ir J Psychol Med 2024; 41:78-85. [PMID: 36082526 DOI: 10.1017/ipm.2022.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies on patient-student relationships have to date largely focused on student attitudes. This study explores attitudes of patients with psychiatric illness in Ireland, towards medical students. Patients' experience of consent for student involvement is an area of concern in previous studies and is also quantified here. METHODS This was a mixed-methods cross-sectional survey of Irish adult psychiatric patients. Quantitative analysis was carried out using SPSS 22 (Statistical Product and Service Solutions, Version 22, IBM). Differences on Likert score between groups (male/female, hospital site, past experience with students/ no experience) were analysed using ordinal logistic regression with a p-value below 0.05 being significant. Qualitative data were analysed by thematic analysis using OpenCode 4.03. RESULTS A total of 340 patients completed the survey. The mean age (sd) was 44.8 (16.3). 52.8% were female, 75.2% were outpatients. 24.3% had never met a medical student. Most patients were comfortable seeing students, but preferred students being passive observers. Patients with previous student experience had higher comfort levels and more positive attitudes. Although most patients (63.7%) strongly agreed they had been asked for consent, only 49.3% felt they had been given sufficient information. Qualitative data revealed preference for adequate information and notice of involvement. Patients felt pressured by student presence in certain circumstances. CONCLUSIONS Psychiatric patients are comfortable with students but many feel inadequately informed. Patients recognise the benefits of interacting with students. More information is needed regarding circumstances in which patients give consent to involvement with students.
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Affiliation(s)
- E M Kolshus
- Clinical Tutor in Clinical Skills, School of Medicine, University of Limerick, Ireland
| | - S Akinmoluwa
- Department of Psychiatry, University Hospital Waterford, Ireland
| | - D Sloan
- Department of Psychiatry, University Hospital Waterford, Ireland
| | - S MacSuibhne
- Department of Psychiatry, St. Luke's General Hospital, Kilkenny, Ireland
| | - E H Kolshus
- Department of Psychiatry & Health Research Institute, University of Limerick, Ireland
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Makins N, Naidoo T, Hassim T, Babalola O, Dormehl C, Mkhabela R, Degni L, Motloutsi KL, Mokhachane M. A cross-sectional study on factors influencing patient participation in undergraduate medical education in a public and private hospital in Johannesburg, South Africa. BMC MEDICAL EDUCATION 2023; 23:687. [PMID: 37735370 PMCID: PMC10514977 DOI: 10.1186/s12909-023-04663-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The active involvement of patients in medical education is a common practice globally. Despite this, there is a global paucity of data on patients' views on their role in medical education. As such this study aimed to identify factors that influence patient participation in undergraduate medical education in public and private hospitals in Johannesburg. METHODS A cross-sectional study was conducted, using a 23-question, self-designed, paper questionnaire to collect data on patients' perceptions of student involvement in their care - with regard to consent, confidentiality, ethics, and patient preferences. Participants were recruited on a voluntary basis in the Departments of Medicine, Surgery, and Gynaecology, at selected hospital sites. Fisher's Exact and Chi-Square statistical tests were used where appropriate. RESULTS Two hundred and one adult patients, comprised of 150 public sector patients and 51 private sector patients, completed the questionnaire. One hundred and sixty-nine patients (84,1%) were willing to participate in undergraduate medical education and no notable difference between these sectors was demonstrated (p = 0,41). The results further demonstrated that the main factors influencing patient participation in undergraduate medical education across both sectors were (1) the presence of a supervising professional, (2) the perceived degree of invasiveness of a procedure, and (3) the perceived expertise of the student. In addition, data across other key themes such as consent, confidentiality, ethics, and patient preferences and perceptions were elucidated. CONCLUSIONS This study demonstrates that the majority of inpatients across the public and private sectors are willing to participate in undergraduate medical education to facilitate the development of healthcare professionals. It also demonstrated that most patients have a positive experience. However, more measures of quality informed consent need to be instituted to optimise the current role of the South African public health sector, whilst facilitating the development of a similar role for the South African private sector in future clinical education. In addition, further research is necessary to evaluate these findings in a South African context.
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Affiliation(s)
- Nicholas Makins
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
| | - Tamiraa Naidoo
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Taariq Hassim
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Ohunayo Babalola
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Charlize Dormehl
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Remind Mkhabela
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lorenzo Degni
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kgotatso Liz Motloutsi
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Mantoa Mokhachane
- Unit for Undergraduate Medical Education, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Moreira BF, Santos CC, Duarte I. Consent for Teaching-The Experience of Pediatrics and Psychiatry. Healthcare (Basel) 2023; 11:healthcare11091270. [PMID: 37174813 PMCID: PMC10178240 DOI: 10.3390/healthcare11091270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 05/15/2023] Open
Abstract
Informed consent protects patients' right of autonomy, as they may refuse to participate in clinical teaching. In Pediatrics, young people aged 16 or over, and with the necessary judgment, may consent; in Psychiatry, consent is also essential due to the personal nature of the subjects addressed. This study aimed mainly to assess the practical application of informed consent in medical education. An observational cross-sectional study was developed, and an interview-like questionnaire was applied to participants waiting for a scheduled consultation for themselves or the person they represented, in Pediatrics and Psychiatry. Only 54% of Pediatrics participants and 75% of Psychiatry participants stated that the physician asked them if they minded the students' presence and an even smaller percentage from both departments affirmed that students introduced themselves as medical students and requested their consent to examine them. Patients feel satisfied to contribute to the students' training, although a considerable percentage of them had experiences without being informed or asked for consent, which represents an evident disrespect for their autonomy. There is a need to intervene and provide an adequate education of ethical values in clinical practice to students.
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Affiliation(s)
- Bárbara Frade Moreira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Department of General and Family Medicine, Family Health Unit (USF) Caminhos do Cértoma, Grouping of Health Centers (ACES) Baixo Mondego, Regional Health Administration (ARS) Centro, 3050-428 Mealhada, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@REISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@REISE, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Mwaka AD, Taremwa S, Adoch W, Achan J, Ainembabazi P, Walego G, Ntayi ML, Bongomin F, Ibingira CB. Patients' attitudes towards involvement of medical students in their care at university teaching hospitals of three public universities in Uganda: a cross sectional study. BMC MEDICAL EDUCATION 2022; 22:519. [PMID: 35780159 PMCID: PMC9250725 DOI: 10.1186/s12909-022-03576-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/16/2022] [Indexed: 05/02/2023]
Abstract
BACKGROUND Comfort of patients with medical students is important and promotes appropriate clinical reasoning and skills development in the students. There is however limited data in this field in Uganda. In this study, we examined the attitudes and comfort of patients attending care at the medical and obstetrics/gynecology specialties in teaching hospitals of three public universities in Uganda. METHODS We conducted a cross sectional study among patients attending care at teaching hospitals for three public universities; Makerere University (Mak), Mbarara University of Science and Technology (MUST), and Gulu University (GU). Logistic regression was used to determine the magnitude of associations between independent and dependent variables. Two-sided p < 0.05 was considered statistically significant. RESULTS Eight hundred fifty-five patients participated in the study. Majority were aged 18 - 39 years (54%, n = 460), female (81%, n = 696) and married (67%, n = 567). Seventy percent (n = 599) of participants could recognize and differentiate medical students from qualified physicians, and had ever interacted with medical students (65%, n = 554) during earlier consultations. Regarding attitudes of patients towards presence of medical students during their consultations, most participants (96%; n = 818) considered involvement of medical students in patients' care as essential ingredient of training of future doctors. Most participants prefer that medical students are trained in the tertiary public hospitals (80%; n = 683) where they attend care. Participants who were single/never married were 68% less likely to recognize and differentiate medical students (aOR = 0.32, 95%CI: 0.22 - 0.53) from other members of the healthcare team as compared with married participants. Participants with university education had 55% lower odds of being comfortable with presence of medical students during consultation compared to those with primary education (aOR = 0.45, 95%CI: 0.21 - 0.94). Participants from MUST teaching hospital had twofold higher odds of being comfortable with presence of medical students compared to participants from Mak teaching hospitals (aOR = 2.01; 95%CI: 1.20 - 3.39). CONCLUSION Patients are generally comfortable with medical students' involvement in their care; they prefer to seek care in hospitals where medical students are trained so that the students may contribute to their care. Medical students need to introduce themselves appropriately so that all patients can know them as doctors in training; this will promote patients' autonomy and informed decisions.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Seti Taremwa
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jennifer Achan
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peruth Ainembabazi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Walego
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Levi Ntayi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Charles Benstons Ibingira
- Department of Anatomy, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
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Gil-Santos I, Santos CC, Duarte I. Medical Education: Patients’ Perspectives on Clinical Training and Informed Consent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137611. [PMID: 35805270 PMCID: PMC9265405 DOI: 10.3390/ijerph19137611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 02/05/2023]
Abstract
There are complex ethical dilemmas inherent to medicine teaching, particularly in clinical practice involving actual patients. Questions must be raised on fulfilling medical students’ training needs while still respecting patients’ fundamental rights to autonomy and privacy. We aimed to assess patients’ perspectives regarding medical students’ involvement in their medical care. An observational, cross-sectional study was developed, and a questionnaire was applied randomly to patients waiting for a consultation/admitted to three distinct departments: General Surgery, Obstetrics/Gynaecology, and Infectious Diseases. Of the 77% interviewed patients who reported previous experiences with medical students, only 59% stated that they were asked for consent for their participation, and 28% stated that students had adequately introduced themselves. Patients from Gynaecology/Obstetrics were the ones who reported lower rates of these practices and were also the ones who were most bothered by students’ presence, stating that they would be more comfortable without the presence of medical students. Male patients received more explanations than female patients regarding the same matters. Thirty-five percent of patients stated that they would feel more comfortable without the medical students’ presence. The study shows a need to pay closer attention to fulfilling patients’ fundamental rights.
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Affiliation(s)
- Inês Gil-Santos
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Department of Obstetrics and Gynecology, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Ivone Duarte
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: ; Tel.: +351-220-426-840
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Alao A, Burford B, Alberti H, Barton R, Moloney S, Vance G. Real-time patients' perspectives about participating in teaching consultations in primary care: A questionnaire study. MEDICAL TEACHER 2021; 43:669-676. [PMID: 33617391 DOI: 10.1080/0142159x.2021.1887840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Patients presenting with undifferentiated illnesses provide valuable learning opportunities for medical students. Evidence detailing the factors that affect patient participation in undergraduate medical education is limited. This study examines how patients regard their participation in teaching consultations in primary care. METHODS We conducted a cross-sectional questionnaire survey in four GP practices. We tested the relationship between variables of interest and willingness to participate, using hierarchical logistic regression. RESULTS We analysed 525 questionnaires. 88% of respondents were willing to have students take part in their consultation, and 72% were willing to see a student alone before seeing the doctor. Older patients and those with less sensitive clinical problems were more likely to participate. Willingness to participate was also associated with patients' perceptions of certain costs and benefits of participation. Respondents had poor knowledge about medical education, and a sizeable minority perceived a lack of autonomy about the presence of students in their encounters. More than one-third of respondents expressed the presence of a clinician as a precondition for approval of students' performing some active roles. DISCUSSION The findings have identified potential interventions to enhance patient involvement including patient education, respecting patient autonomy, and ensuring appropriate student supervision.
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Affiliation(s)
- Adedoyin Alao
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Roger Barton
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Moloney
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Vance
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Midwinter E. Evaluating a new trauma and critical care management course for nurses. Emerg Nurse 2021; 29:21-27. [PMID: 33619922 DOI: 10.7748/en.2021.e2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/09/2022]
Abstract
A new practical-based course for nurses on the management of major trauma has been developed using high-level simulation and moulage to deliver education based on established trauma competencies. The Nurse Trauma and Critical Care course was developed by nurses with input from the Anaesthesia Trauma and Critical Care group and has been accredited by the Royal College of Surgeons. This article describes the development of the course and discusses the findings of a course evaluation that aimed to measure candidates' confidence and knowledge after completion.
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Omid A, Haghani F, Adibi P. Emotional Intelligence: An Old Issue and a New Look in Clinical Teaching. Adv Biomed Res 2018. [PMID: 29531930 PMCID: PMC5840965 DOI: 10.4103/2277-9175.225926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In this paper, a novel model of clinical teachers with social and emotional competency which is emphasized on the importance of clinical teacher's social and emotional competence is presented. In this model, we supposed that a teacher with social and emotional competence can manage her/his emotions and has the ability to personal development and well-being. Such teacher has the competency of empathy, communication with the patients, teamwork, and collaboration to provide successful patient-centered care and relationship-centered care. He/she will be success in clinical supervision, role modeling, and mentoring by providing appropriate relationship with students. This teacher can influence and build bonds that will be effective for clinical management and leadership. In addition, it will affect the hidden and informal curriculum with the awareness of the context. These factors establish an appropriate learning environment to achieve students’ academic, professional, social, and emotional outcomes and create an appropriate health care environment that influences the successful care of patient and patient's satisfaction. We reviewed a broad body of research to support our proposed model and finally proposed agendas for future research.
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Affiliation(s)
- Athar Omid
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Haghani
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Forbes DR, Nolan D. Factors associated with patient-satisfaction in student-led physiotherapy clinics: A qualitative study. Physiother Theory Pract 2018; 34:705-713. [PMID: 29308961 DOI: 10.1080/09593985.2018.1423592] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Student-led physiotherapy clinics are a valuable means for providing clinical education opportunities for student learning and providing cost-effective services to the public. Understanding patient satisfaction within the student-led physiotherapy clinic setting is important to inform organizational, educational, and clinical processes that aim to balance both student learning experiences and quality patient care. DESIGN A cross-sectional qualitative design using semi-structured interviews. RESULTS A total of 20 patients from three different university student-led physiotherapy clinics were interviewed. Five major themes were associated with patient satisfaction, style of supervision, student-supervisor relationship, quality of physiotherapy care, student qualities and cost, and location of the service. CONCLUSION The results emphasize the importance placed by patients on effective communication, as well as the relationship between the supervisor and student overseeing their care. The findings highlight the influence of both the student and supervisor on patient satisfaction and provide insight into the style of student supervision from the perspective of the patient.
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Affiliation(s)
- Dr Roma Forbes
- a School of Health and Rehabilitation Sciences, Physiotherapy , The University of Queensland , Brisbane , Australia
| | - Damien Nolan
- a School of Health and Rehabilitation Sciences, Physiotherapy , The University of Queensland , Brisbane , Australia
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Dearman SP, Joiner AB, Gordon M, Vince G. Experiences of Patients with Mental Illness' Interactions with Medical Students: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:4-11. [PMID: 29202663 PMCID: PMC5788124 DOI: 10.1177/0706743717730824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mental health is a key area for learning within undergraduate medical education. Given the nature of mental illness, interactions may have the potential to uniquely affect patients. This study set out to systematically review studies reporting experiences and perceptions of patients with mental illness' clinical interactions with medical students. This includes which factors encourage patients to interact with medical students and if patients perceive negative and positive effects from these interactions. METHOD Studies reporting patient experiences of involvement in undergraduate medicine were included. A standardised search of online databases was carried out independently by 2 authors and consensus reached on the inclusion of studies. Data extraction and quality assessment were also completed independently, after which a content analysis of interventions was conducted and key themes extracted. Studies were included from peer-reviewed journals, in any language. RESULTS Eight studies from 5 countries were included, totaling 1088 patients. Most patients regarded interacting with medical students as a positive experience. Patients described feeling comfortable with medical students, and the majority believed it is important for students to 'see real patients'. Patients described benefits to them as enjoyment, being involved in student education, and developing an illness narrative. CONCLUSIONS Results suggest that most patients with mental illness want to interact with medical students, and this should be encouraged during student placements. Further research, however, is required to understand in more depth what else can be done to improve the comfort and willingness for patients to interact with students, including barriers to this.
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Affiliation(s)
- Samuel P Dearman
- 1 Cumbria Partnership NHS Foundation Trust, Carleton Clinic, Carlisle, United Kingdom
| | - Adam B Joiner
- 2 Cumbria Partnership NHS Foundation Trust, Dane Garth, Furness General Hospital, Barrow-in-Furness, United Kingdom
| | - Morris Gordon
- 3 University of Central Lancashire, Preston, United Kingdom.,4 Blackpool Hospital, Blackpool, United Kingdom
| | - Gill Vince
- 5 Lancaster University Medical School, Lancaster, United Kingdom
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Liberatore F, Angerer A, Kriech S. The balance of patient and learners needs in non-profit, public and for-profit teaching hospitals: An analysis of average patient satisfaction ratings of hospitals on a German hospital rating platform. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1397251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Florian Liberatore
- Zurich University of Applied Sciences, Winterthurer Institute for Health Economics, Winterthur, Switzerland
| | - Alfred Angerer
- Zurich University of Applied Sciences, Winterthurer Institute for Health Economics, Winterthur, Switzerland
| | - Sarah Kriech
- Zurich University of Applied Sciences, Winterthurer Institute for Health Economics, Winterthur, Switzerland
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Omid A, Haghani F, Adibi P. Clinical teaching with emotional intelligence: A teaching toolbox. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:27. [PMID: 27904573 PMCID: PMC5122235 DOI: 10.4103/1735-1995.181983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/02/2015] [Accepted: 02/17/2016] [Indexed: 12/30/2022]
Abstract
Background: Emotional intelligence (EI) helps humans to perceive their own and others’ emotions. It helps to make better interpersonal communication that consequently leads to an increase in everyday performance and professional career. Teaching, particularly teaching in the clinical environment, is among the professions that need a high level of EI due to its relevance to human interactions. Materials and Methods: We adopted EI competencies with characteristics of a good clinical teacher. As a result, we extracted 12 strategies and then reviewed the literatures relevant to these strategies. Results: In the present article, 12 strategies that a clinical teacher should follow to use EI in her/his teaching were described. Conclusion: To apply EI in clinical settings, a teacher should consider all the factors that can bring about a more positive emotional environment and social interactions. These factors will increase students’ learning, improve patients’ care, and maintain her/his well-being. In addition, he/she will be able to evaluate her/his teaching to improve its effectiveness.
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Affiliation(s)
- Athar Omid
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Haghani
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Department of Gastroenterology, Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Woolner A, Cruickshank M. What do pregnant women think of student training? CLINICAL TEACHER 2015; 12:325-30. [PMID: 26109149 DOI: 10.1111/tct.12312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical experience is fundamental for medical and midwifery student education. Patient willingness for student participation is perceived as low in obstetrics and gynaecology. We explored the views of pregnant women on medical and midwifery student training. METHODS Pregnant women were invited to participate in a cross-sectional survey at antenatal out-patient clinics at a maternity hospital serving a regional population during June and July 2012. RESULTS Only 53 per cent (110/206) of women reported that they would allow a medical student to assist with the delivery of their baby, and 61 per cent (127/206) would allow a midwifery student to assist; however, 84 per cent (174/206) of women were willing to undergo an obstetric abdominal examination by a medical student, and similarly 87 per cent (180/206) agreed to an examination by a midwifery student. Primigravid women were significantly less likely to agree to student assistance at delivery compared with parous women for medical (p < 0.01) and midwifery students (p = 0.02). Women appear generally more willing to accept midwifery students compared with medical students (p < 0.01). Women who would decline student participation expressed concerns over lack of student supervision, desire for privacy, student training level, need for 'experienced' staff and concerns regarding first or previous complicated pregnancies. Patient willingness for student participation is perceived as low in obstetrics and gynaecology DISCUSSION Negative attitudes remain towards students in the labour ward. Women have concerns over student supervision and competence. Research is needed to address women's reluctance to student participation during labour and delivery to determine if particular fears exist related to birth. The development of innovative educational tools could address specific modifiable concerns that pregnant women have with student training in the labour ward.
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Affiliation(s)
- Andrea Woolner
- Obstetrics & Gynaecology, Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, UK
| | - Margaret Cruickshank
- Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, UK
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Öster C, Bäckström S, Lantz I, Ramklint M. Psychiatric patients' perspectives of student involvement in their care. BMC MEDICAL EDUCATION 2015; 15:69. [PMID: 25879902 PMCID: PMC4393592 DOI: 10.1186/s12909-015-0352-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND In the education of professionals in psychiatry, one challenge is to provide clinical placements with opportunities for students to interact and have direct contact with patients. The aim of this study was to explore Swedish psychiatric patients' perspectives on student participation in their care. METHOD In a cross-sectional survey design, 655 adult psychiatric patients at a university hospital completed questionnaires. These questionnaires included statements about student involvement, student gender, attitudes towards student participation as well as two open-ended questions. Data were analyzed quantitatively and qualitatively. RESULTS The majority of the patients were comfortable with student participation. There were no differences between patients in wards compared to outpatients but patients who previously had students involved in their care reported higher comfort levels and a more positive attitude. Female patients were less comfortable with male students and very young students. Patients stressed the importance of being informed about the opportunity to refuse student participation. More detailed information given before the consultation as well as the importance of the student showing a professional attitude was conditions that could enable more patients to endorse student participation. CONCLUSION The psychiatric patients' overall positive attitudes are in line with previous findings from other specialties and countries. The results support both altruistic motives and experience of personal gains by student involvement. More detailed information given beforehand would enable more patients to consider student participation.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, SE-751 85, Sweden.
| | - Susan Bäckström
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, SE-751 85, Sweden.
| | - Ingrid Lantz
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, SE-751 85, Sweden.
| | - Mia Ramklint
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, SE-751 85, Sweden.
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Vaughn JL, Rickborn LR, Davis JA. Patients' Attitudes Toward Medical Student Participation Across Specialties: A Systematic Review. TEACHING AND LEARNING IN MEDICINE 2015; 27:245-253. [PMID: 26158326 DOI: 10.1080/10401334.2015.1044750] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED 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.
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Affiliation(s)
- John L Vaughn
- a Department of Internal Medicine , The Ohio State University , Columbus , Ohio , USA
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Drevs F, Gebele C, Tscheulin DK. The patient perspective of clinical training—An empirical study about patient motives to participate. Health Policy 2014; 118:74-83. [DOI: 10.1016/j.healthpol.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 05/05/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
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Cawich SO, Barnett AT, Crandon IW, Drew SD, Gordon-Strachan G. From the patient's perspective: is there a need to improve the quality of informed consent for surgery in training hospitals? Perm J 2014; 17:22-6. [PMID: 24361016 DOI: 10.7812/tpp/13-032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was performed to evaluate the presurgical informed consent process at a training hospital in Jamaica. METHODS A postoperative survey was administered to all consecutive able and willing adult patients who underwent the presurgical informed consent process with surgical residents during a 5-week period. Information was collected on patient demographics and patients' perception and satisfaction with the informed consent process. RESULTS There were 210 surveys completed. Patients were unaware of the training status of the physician involved with their presurgical informed consent process in 48% of cases. Nineteen (9%) patients were instructed to sign a consent document without any discussion. An attempt was made to secure a signature after some discussion with the remaining 191 patients. Patients reported that details of the operation were discussed 74% of the time; potential benefits of the surgery, 72% of the time; potential morbidity, 84% of the time; potential mortality, 19% of the time; predicted postoperative course, 49% of the time; projected recovery, 26% of the time; and other treatment options, 33% of the time. Forty-five patients believed that they were instructed to sign the consent document with minimal discussion. At termination of the consent process, only 70% of the 210 patients reported that they signed the consent form voluntarily. Overall, 67% of patients thought the current informed consent process was unsatisfactory. CONCLUSION The current informed consent process in use in the surgical training program at the University Hospital of the West Indies requires improvement to meet expected ethical and legal standards.
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Affiliation(s)
- Shamir O Cawich
- Lecturer in the Department of Clinical Surgical Sciences at the University of West Indies in Port of Spain, Trinidad and Tobago.
| | - Alan T Barnett
- Lecturer in the Department of Surgery at the University of West Indies in Kingston, Jamaica.
| | - Ivor W Crandon
- Lecturer in the Department of Surgery at the University of West Indies in Kingston, Jamaica.
| | - Samantha D Drew
- House Officer in the Department of Surgery at the Southampton General Hospital, United Kingdom.
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Physician shadowing by college students: what do patients think? BMC Res Notes 2014; 7:146. [PMID: 24629141 PMCID: PMC3975134 DOI: 10.1186/1756-0500-7-146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to determine patients' perceptions of physician shadowing by college students. METHODS Thirty-two patients who agreed to have a college student shadow their physician participated in semi-structured interviews during July and August 2013 at two outpatient family medicine centers. Qualitative techniques were utilized to analyze the transcripts of the patient interviews and identify common themes. RESULTS The majority of patients (78.1%) felt the college student had a neutral effect on their visit and denied having concerns about confidentiality (87.5%). No patient felt that having the college student present affected their ability to maintain a trusting relationship with their physician. Three themes emerged from the qualitative analysis: benefits to students, willing participation and sensitive issues. Most patients (78.5%) recognized that the student was in college or was a premedical student. The overwhelming majority of patients stated that they would have a college student shadow their physician again in the future. CONCLUSIONS Despite concerns raised by other authors about the possible negative effects of physician shadowing by college students, this study shows that patients feel the impact to be primarily neutral and that there are many perceived benefits to both student and patient.
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How patients choose hospitals: Using the stereotypic content model to model trustworthiness, warmth and competence. Health Serv Manage Res 2013; 26:95-101. [DOI: 10.1177/0951484813513246] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In many countries, policy initiatives force the implementation of demand-driven healthcare systems to encourage competition among providers. When actively choosing hospitals, consumers can compare data on the quality of hospital performance among providers. However, patients do not necessarily take full advantage of comparative quality information but instead use a number of readily available proxies to evaluate provider trustworthiness. According to the stereotypic content model, organizational trustworthiness is built on stereotypical perceptions of hospitals' competence and warmth, reflected by visible hospital characteristics such as ownership and teaching status, and size. We introduce a theoretical framework on stereotypic quality perceptions that brings together fragmented findings in health services research on patient quality expectations of hospital characteristics. The model provides a basis for further research and recommendations for improved hospital communication strategies. The study suggests that researchers as well as hospital management should pay more attention to stereotypical patient quality perceptions and their impact on hospital choice to understand patients' quality evaluations better.
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Gierk B, Harendza S. Patient selection for bedside teaching: inclusion and exclusion criteria used by teachers. MEDICAL EDUCATION 2012; 46:228-233. [PMID: 22239336 DOI: 10.1111/j.1365-2923.2011.04054.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT Bedside teaching encounters on hospital wards offer medical students opportunities to learn key medical and interpersonal skills. Although many aspects of bedside teaching have been studied, not much is known about the selection process used by medical teachers to find patients for these encounters. Patient selection could have a substantial impact on medical students' clinical experiences. Therefore, we studied the ways in which medical teachers select patients for bedside teaching and tried to determine the factors that affect patient selection. METHODS Using a qualitative research approach, we interviewed 15 teachers from three departments within the Medical Faculty at Hamburg University on how they choose patients for bedside teaching encounters. We extracted selection criteria from the transcripts of the audio-recorded interviews and identified other factors that influenced selection. RESULTS One main category and two minor categories of factors relevant to patient selection were identified: educational; bio-psycho-social, and structural. Medical teachers look primarily for patients who have diseases that fit their conceptions of the learning objectives of the lessons in question. The two minor categories influence their choice of patients in different ways. By finding a balance between these categories, they decide which patients are eligible for participation. As a result of these selection criteria, some patients are more likely to become involved in clinical teaching, whereas others may be omitted. CONCLUSIONS Patient selection for bedside teaching is based on several criteria. Non-representative patient selection may narrow the learning experiences of medical students. Curriculum planners need to be aware that specific aspects of medical care may be neglected as a result of the exclusion of some patients. Teacher training and additional teaching formats should be provided to ensure that these are covered.
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Affiliation(s)
- Benjamin Gierk
- Department of Internal Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
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Avila-Alvarez A, Gonzalez-Rivera I, L. Fernandez-Trisac J, I. Taboada-Perianes M, Rodriguez-Gonzalez B, Centeno-Cortes A, Diaz-Gomez M, Rei-Serra T, Jacome-Feijoo R. Evaluation of participants' feedback after a simulation-based training in neonatal resuscitation using a realistic delivery room. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojped.2012.24047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kravetz AJ, Anderson CI, Shaw D, Basson MD, Gauvin JM. Patient Misunderstanding of The Academic Hierarchy is Prevalent and Predictable. J Surg Res 2011; 171:467-72. [PMID: 20934720 DOI: 10.1016/j.jss.2010.07.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 05/29/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Rose DZ, Kasner SE. Informed consent: the rate-limiting step in acute stroke trials. Front Neurol 2011; 2:65. [PMID: 22022320 PMCID: PMC3195267 DOI: 10.3389/fneur.2011.00065] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022] Open
Abstract
Successful implementation of a randomized clinical trial (RCT) for neuro-vascular emergencies such as cerebral infarction, intracerebral hemorrhage, or subarachnoid hemorrhage is extraordinarily challenging. Besides establishing an accurate, hyper-expedited diagnosis among many mimics in a person with acute neurological deficits, informed consent must be obtained from this vulnerable group of patients who may be unable to convey their own wishes, grasp the gravity of their situation, or give a complete history or examination. We review the influences, barriers, and factors investigators encounter when providing established and putative stroke therapies, and focus on informed consent, the most important research protector of human subjects, as the rate-limiting step for enrollment into acute stroke RCTs. The informed consent process has received relatively little attention in the stroke literature, but is especially important for stroke victims with acute cognitive, aural, lingual, motor, or visual impairments. Consent by a surrogate may not accurately reflect the patient’s wishes. Further, confusion about trial methodology, negative opinions of placebo-controlled studies, and therapeutic misconception by patients or surrogates may impede trial enrollment and requires further study. Exception from informed consent offers an opportunity that is rarely if ever utilized for stroke RCTs. Ultimately, advancing the knowledge base and treatment paradigms for acute stroke is essential but autonomy, beneficence (non-malfeasance), and justice must also be carefully interwoven into any well-designed RCT.
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Affiliation(s)
- David Z Rose
- Stroke Division, Department of Neurology, University of South Florida, Tampa General Hospital Tampa, FL, USA
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Pinnock R, Weller J, Shulruf B, Jones R, Reed P, Mizutani S. Why parents and children consent to become involved in medical student teaching. J Paediatr Child Health 2011; 47:204-10. [PMID: 21244543 DOI: 10.1111/j.1440-1754.2010.01937.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Clinical experience in paediatrics is essential for medical undergraduates. This is the first study, of which we are aware, to examine why children of different ages admitted acutely to hospital and their parents agree to become involved in medical student teaching. We wanted to establish whether they considered that they needed to give consent before seeing medical students, whether this was routinely sought and what influenced their decisions. METHODS Data were collected using questionnaires and semi-structured interviews of parents and children. RESULTS Questionnaires were completed by 105 parents of children less than 6 years old, and 34 children between 10 years and 15 years old and their parents. Interviews were conducted with 32 children between the ages of 6 and 10 years and their parents. Most parents and children consider that they have a responsibility to teaching but must always be asked for consent. They were motivated by altruism, but fear of emotional distress or pain can lead them to refuse. Younger children may not be able to give reasons for not wanting to see a medical student but sometimes have firm views, which must be respected. Having seen a medical student previously did influence children's or parents' opinions. Most children who have seen a medical student were prepared to see students again. CONCLUSION Medical students can be reassured that parents and children admitted acutely to a children's hospital have a positive attitude to student involvement and are prepared to help them learn clinical skills, but consent must always be obtained and the child's perspective must always be considered.
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Affiliation(s)
- Ralph Pinnock
- General Paediatrics, Starship Children's Hospital, University of Auckland, Auckland, New Zealand.
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Barnett AT, Cawich SO, Crandon IW, Lindo JF, Gordon-Strachan G, Robinson D, Ranglin D. Informed consent from patients participating in medical education: a survey from a university hospital in Jamaica. BMC Res Notes 2009; 2:252. [PMID: 20003471 PMCID: PMC2803186 DOI: 10.1186/1756-0500-2-252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 12/15/2009] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Medical students at the University of the West Indies receive clinical training by passing through a series of hospital rotations at the University Hospital of the West Indies (UHWI). Many of these patients are unaware that medical students may be involved in their care. We performed this study to determine patient awareness and their willingness to participate in research and teaching activities. FINDINGS All consecutive patients admitted to the UHWI between May 1, 2006 and May 29, 2006 who required elective or emergency surgical procedures were prospectively identified These patients were interviewed using a standardised pre-tested questionnaire about their knowledge and willingness to have medical students participate in the delivery of their hospital care. Data was analyzed using SPSS Version 12.0. There were 83 (39.5%) males and 127 (60.5%) females interviewed. The patients were unaware of the grade of the medical professional performing their interview/examination at admission in 157 (74.8%) cases or the grade of medical professional performing their operations in 101 (48.1%) cases. Only 14 (6.7%) patients were specifically asked to allow medical students to be present during their clinical evaluation and care. When specifically asked, 1 patient declined. Had they been asked, 196 (93.3%) patients would have voluntarily allowed medical student involvement. Only 90 (42.9%) patients were made aware that they were admitted to an academic centre with research interests. Only 6 (6.7%) patients declined. Had they been asked, 84 (93.3%) patients would be willing to participate in teaching or research projects. CONCLUSIONS As medical educators, we are responsible to adhere to ethical and legal guidelines when we interact with patients. It is apparent that there is urgent need for policy development at the UWI to guide clinicians and students on their interactions with patients.
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Affiliation(s)
- Alan T Barnett
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Shamir O Cawich
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Ivor W Crandon
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - John F Lindo
- Department of Microbiology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Georgiana Gordon-Strachan
- Research Centre, Dean's Office, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Diaqa Robinson
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
| | - Deonne Ranglin
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica
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Westberg K, Duchek M, Sandlund M, Lynöe N. Informed Consent for Clinical EducationRandomized Study of Two Different Strategies at a Urology Surgery. ACTA ACUST UNITED AC 2009; 38:490-4. [PMID: 15841784 DOI: 10.1080/00365590410015876] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Katarina Westberg
- Department of Public Health and Clinical Medicine, Medical Ethics, Umeå University, Umeå, Sweden
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Ashley P, Rhodes N, Sari-Kouzel H, Mukherjee A, Dornan T. 'They've all got to learn'. Medical students' learning from patients in ambulatory (outpatient and general practice) consultations. MEDICAL TEACHER 2009; 31:e24-31. [PMID: 19330660 DOI: 10.1080/01421590802464445] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The dynamics of effective teaching consultations need to be better understood. AIM Find from medical students, patients and doctors how to optimize learning in ambulatory consultations. METHODS Patients and students independently gave semi-structured exit interviews after 25 ambulatory teaching consultations during a clinical attachment set up experimentally to strengthen students' ambulatory learning. The results of an abbreviated grounded theory analysis were checked in three focus group discussions with teachers and students. RESULTS Patients and students identified strongly with one another and benefited from teaching consultations in parallel ways yet defaulted to passive roles. Patients deferred to professional expertise whilst students were uncertain what was expected of them, feared harming patients and feared being showed up as ignorant. The educational value of consultations was determined by doctors' ability to promote student-patient interaction. CONCLUSIONS In the most effective teaching consultations, doctors promoted a level of participation that realized patients' and students' mutual sense of responsibility by orientating them to one another, creating conditions for them to interact, promoting and regulating discourse, helping students to perform practical tasks and debriefing them afterwards. Those broad conclusions translate into 18 practical recommendations for supervising a medical student in an outpatient clinic or surgery.
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Heathcote J. What motivates patients to become involved in postgraduate medical training in a family planning clinic? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008. [DOI: 10.1783/jfp.34.2.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Doshi M, Acharya S, Wall D. Mentally ill inpatients' experiences and opinions on seeing medical students: a questionnaire study. MEDICAL TEACHER 2006; 28:568-70. [PMID: 17074709 DOI: 10.1080/01421590600627342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Research involving general patients suggests that most patients agree to be involved in medical education but prefer not to discuss personal or stress related issues with/in front of medical students. We explore the opinions and experiences of mentally ill in-patients of their involvement in undergraduate medical education in psychiatry. The study shows that patients attach importance to students seeing real patients and that the patients are happy to be seen by medical students. Most patients benefit from seeing a student and few suffer detriment. They experience anxiety prior to the student-patient interview which dissipates during the interview. Mentally ill patients agree to see medical students for similar reasons to other patients. It is important to obtain full consent from patients who see medical students.
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Affiliation(s)
- Monica Doshi
- Medical Teaching Centre, Warwick Medical School, Coventry, CV4 7AL, UK.
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Abstract
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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Affiliation(s)
- Amitai Ziv
- The Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Westberg K, Sandlund M, Lynöe N. The effect of giving information in advance on the clinical training of medical students. MEDICAL EDUCATION 2005; 39:1021-6. [PMID: 16178829 DOI: 10.1111/j.1365-2929.2005.02267.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
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.
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Affiliation(s)
- Katarina Westberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Macdonald J. A survey of staff attitudes to increasing medical undergraduate education in a district general hospital. MEDICAL EDUCATION 2005; 39:688-95. [PMID: 15960789 DOI: 10.1111/j.1365-2929.2005.02197.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching--their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching--as both student numbers and service workloads continue to rise. METHODS Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. RESULTS The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. CONCLUSIONS This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative.
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Affiliation(s)
- John Macdonald
- Department of Undergraduate Medical Education, Northampton General Hospital, Northants, UK.
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Lake FR, Ryan G. Teaching on the run tips 4: teaching with patients. Med J Aust 2004; 181:158-9. [PMID: 15287835 DOI: 10.5694/j.1326-5377.2004.tb06208.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Accepted: 05/31/2004] [Indexed: 11/17/2022]
Affiliation(s)
- Fiona R Lake
- Education Centre, Faculty of Medicine and Dentistry, University of Western Australia, First Floor, N Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia.
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Affiliation(s)
- Amanda Howe
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
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Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2003; 78:783-8. [PMID: 12915366 DOI: 10.1097/00001888-200308000-00006] [Citation(s) in RCA: 491] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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Affiliation(s)
- Amitai Ziv
- The Chaim Sheba Medical Center, and Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
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Walters K, Buszewicz M, Russell J, Humphrey C. Teaching as therapy: cross sectional and qualitative evaluation of patients' experiences of undergraduate psychiatry teaching in the community. BMJ 2003; 326:740. [PMID: 12676843 PMCID: PMC152635 DOI: 10.1136/bmj.326.7392.740] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Kate Walters
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London N19 5LW.
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Mathers J, Parry J, Lewis S, Greenfield S. What impact will the 'conversion' of two district general hospitals into teaching hospitals have? Views from the field. MEDICAL EDUCATION 2003; 37:223-232. [PMID: 12603761 DOI: 10.1046/j.1365-2923.2003.01434.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIM To gather opinions from a variety of healthcare professionals in Birmingham and the Black Country as to the potential impact of 'converting' 2 district general hospitals into teaching hospitals. METHODS Thirty-three semi-structured interviews were conducted with healthcare professionals including Directors of Public Health, Community Health Council Chief Officers, Trust Chief Executives, medical directors, trust managerial and consultant staff, junior doctors and nurses. Interviewees were asked to outline what they felt the major impacts of the 'conversion' to teaching status were likely to be. RESULTS Five main thematic areas were identified from the interviews. Three of these related to the medical students receiving their clinical training in the new teaching hospitals, the teachers undertaking new or additional teaching duties and the patients being treated in the new teaching settings. Interviewees also identified several organisational effects relating to the new, established and non-teaching hospitals in the locality and discussed potential impacts outside of health care settings. CONCLUSIONS The majority of views expressed by participants were positive citing potential benefits from developments in teaching provision. Areas of concern generally related to the need for successful implementation of the changes within clinically focused environments rather than to the effects of teaching per se. The impacts consequent to the reconfiguration of district general hospitals to teaching hospitals should be evaluated by appropriately designed longitudinal studies.
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Affiliation(s)
- Jonathan Mathers
- Department of Public Health & Epidemiology, University of Birmingham, UK.
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Owen H, Plummer JL. Improving learning of a clinical skill: the first year's experience of teaching endotracheal intubation in a clinical simulation facility. MEDICAL EDUCATION 2002; 36:635-642. [PMID: 12109985 DOI: 10.1046/j.1365-2923.2002.01260.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND All medical practitioners should be able to manage the airway of an unconscious patient. Endotracheal intubation is the most effective method of securing the airway but is a complex skill requiring much practice. Traditionally, endotracheal intubation has been taught on patients, but this is not ideal. METHODS We have developed a short course on endotracheal intubation taught in a clinical simulation unit (CSU). This unit has a large range of airway trainers and patient simulators, some of which can be manipulated to make intubation more difficult. Endotracheal intubation is taught in a series of steps in order to avoid cognitive overload. Each step is taught on an airway trainer that has no difficult features. Once this is mastered, more difficult situations are presented which require application of new techniques and/or equipment. In this way, students learn useful schemas to apply clinically. RESULTS In 1 year, over 100 students and trainees were taught endotracheal intubation in the CSU. The ideal group size was found to be two students and one trainer. It took 75 to 90 minutes for most students to reach a standard where they could be expected to safely perform the technique on a patient. All comments on learning endotracheal intubation in this setting were positive. Many students felt more comfortable learning on a model than on a patient. CONCLUSION Learning clinical procedures on simulators is becoming an essential part of medical education. More than one airway trainer may be needed to give students the expertise to perform endotracheal intubation on patients.
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Affiliation(s)
- Harry Owen
- Department of Anaesthesia, Flinders University of South Australia and Flinders Medical Centre, Bedford Park, South Australia.
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Robertson A, Gibbons P, Carter A. Student and patient perspectives on the interaction between supervisors, students and patients during the clinical teaching experience at a university out-patient clinic: a descriptive pilot study. J Osteopath Med 2002. [DOI: 10.1016/s1443-8461(02)80029-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Westberg K, Lynøe N, Lalos A, Löfgren M, Sandlund M. Getting informed consent from patients to take part in the clinical training of students: randomised trial of two strategies. BMJ (CLINICAL RESEARCH ED.) 2001; 323:488. [PMID: 11532842 PMCID: PMC48135 DOI: 10.1136/bmj.323.7311.488] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- K Westberg
- Medical Ethics, Umeå University, S-901 87 Umeå, Sweden
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Waterbury JT. Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical students. MEDICAL EDUCATION 2001; 35:286-294. [PMID: 11260453 DOI: 10.1046/j.1365-2923.2001.00865.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
CONTEXT The clinical teaching of medical students is essential to the continuation of medicine, but it has a major impact on the patient's health care and autonomy. Some people believe that there is a moral obligation for patients to participate in this training. Such an obligation, real or perceived, may endanger patients' autonomy. OBJECTIVES The author makes a critical analysis of the main arguments he encounters supporting such an obligation. These arguments are: (1) the furthering of medical education; (2) compensation when uninsured or unable to pay; (3) an equitable return for the care received in a teaching hospital, and (4) fulfilment of a student's need for (and some say right to) clinical training. METHODS Related literature is reviewed in search of evidence and/or support for such arguments. CONCLUSIONS The review reveals that these arguments either cannot be verified or do not necessarily place any obligations on the patient. It is argued that, while a medical student may have a right to clinical education, the obligation to fulfil this right rests with the medical university and not on the patients of its teaching hospitals. SOLUTIONS Several proposals are made about how to satisfy this need without infringing on the patient's right to refuse participation, explaining the patient's rights and role in clinical teaching, and the use of standardized patients where necessary.
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Affiliation(s)
- J T Waterbury
- Pécs University Medical School, Pécs Science University, Pécs, Hungary
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Spencer J, Blackmore D, Heard S, McCrorie P, McHaffie D, Scherpbier A, Gupta TS, Singh K, Southgate L. Patient-oriented learning: a review of the role of the patient in the education of medical students. MEDICAL EDUCATION 2000; 34:851-7. [PMID: 11012935 DOI: 10.1046/j.1365-2923.2000.00779.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIM To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research. METHODS Literature review. RESULTS Direct contact with patients can be seen to play a crucial role in the development of clinical reasoning, communication skills, professional attitudes and empathy. It also motivates through promoting relevance and providing context. Few studies have explored this area, including effects on the patients themselves, although there are examples of good practice in promoting more active participation. CONCLUSION The Cambridge framework is a tool for evaluating the involvement of patients in the educational process, which could be used by curriculum planners and teachers to review and monitor the extent to which patients are actively involved. Areas for further research include looking at the 'added value' of using real, as opposed to simulated, patients; more work on outcomes for patients (other than satisfaction); the role of real patients in assessment; and the strengths and weaknesses of different models of patient involvement.
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Affiliation(s)
- J Spencer
- University of Newcastle upon Tyne, New Castle upon Tyne, UK
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