Patients' attitude towards bedside teaching in Tunisia

Obstetrics and gynecology patients' perceptions about bedside teaching at a Saudi teaching hospital

BACKGROUND

Bedside teaching (BST) is a crucial component of medical education. It entails the interaction of students with patients in outpatient clinics and inpatient wards under the supervision of their tutors in order to improve the clinical skills of the students and, ultimately, patient outcomes. This teaching relies heavily on patients' willingness and cooperation. The aim of this study was to assess the perception of Obstetrics and Gynecology (OB/GYN) patients regarding the presence and participation of medical students in BST.

MATERIALS AND METHODS

A cross-sectional survey was conducted among OB/GYN patients at the outpatient clinics and inpatient wards at King Fahd Hospital of the University (KFHU) in Al-Khobar from January 1 to April 30, 2023. Data were collected online through the Google Drive survey tool using a validated and pilot tested questionnaire. Data were analyzed utilizing SPSS version 26.0. Chi-squared test was employed to test for association between two categorical variables. Multiple logistic regression model was used to determine variables associated with positive attitudes.

RESULTS

A total of 507 patients completed online questionnaire. A highly positive patients' attitude was observed toward the presence and participation of medical students during BST with a mean score of 81.8 ± 10.4. The acceptance rates were higher for female students compared to male students (91.9% vs 61.7%) and for senior doctors compared to junior doctors (89.9% vs 58.9%). Patients who came to the outpatient clinics were also more likely to accept students' presence than those who went to hospital wards. Age, marital status, and previous clinic visits were positively associated with the acceptance level of the presence and involvement of medical students in BST without a significant difference.

CONCLUSION

In general, patients had a good perception of medical students' engagement in their care and that the gender of the medical students/doctors and clinical setting could affect this perception. Raising patients' awareness of their valuable role in male medical students' and doctors' education should be raised, as this will increase their acceptance during BST.

Patients' perspectives on their motivations for participating in non-clinical medical teaching and what they gain from their experience: a qualitative study informed by critical theory

In 2019-2021, we engaged in a project aimed at developing, implementing, and evaluating an educational intervention actively involving patient-teachers in undergraduate medical education at Université Laval, Quebec, Canada. Patient-teachers were invited to participate in small group discussion workshops during which medical students deliberate on legal, ethical, and moral issues arising from medical practice. Patients were expected to bring other perspectives, based on their experience with illness and the healthcare system. Little is still known about patients' perspectives on their participation experience in such context. Informed by critical theory, our qualitative study aims to document,: (i) the motivating factors for patients' participation in our intervention; and (ii) what patients gained from the experience. Data collection was based on 10 semi-structured interviews with patient-teachers. A thematic analysis was conducted using NVivo software. Motivators for participation arose from: (i) perceived consistency between patients' individual characteristics and those of the project, and (ii) conceiving the project as a means to reach individual and social goals. What patients gained mainly refers to (1) the appreciation of a positive, enriching, motivating yet uncomfortable and destabilizing experience; (2) a deconstruction of biases against the medical field and critical thinking about their own experience; (3) new knowledge, with a potential impact on their future interactions with the healthcare system. Results reveal patients as non-neutral thinking and knowing subjects, engaged in the participation experience as active teachers and learners. They also highlight the empowering and emancipatory nature of the learning gained through patients' participation experience. These conclusions prompt us to promote transformative interventional approaches that question the pervasive power issues in medical teaching and value patients' specific knowledge in teaching and learning the Art of Medicine.

Student mistakes and teacher reactions in bedside teaching

We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.

Patients' attitudes towards involvement of medical students in their care at university teaching hospitals of three public universities in Uganda: a cross sectional study

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.

Determinants of Nursing Students’ Confidence in Peripheral Intravenous Catheter Insertion and Management

BACKGROUND: Peripheral intravenous catheter (PIVC) is one of the medical devices commonly inserted in hospitalized patients, both adults and pediatrics. PIVC has crucial functions for delivering drugs, fluids, blood transfusions, and diagnostic tests for patients. Thus, nursing students must be confident in terms of insertion and management of this device. However, studies assessing nursing students’ confidence and its determinants are still limited. AIM: This study aims to examine the internship nursing student’s confidence in PIVC insertion and management in adult patients and its contributing factors. METHODS: A cross-sectional study was conducted to measure internship nursing students’ confidence in PIVC cannulation and management in adult patients as well as its contributing factors. Purposive samples of 100 nursing students in Yogyakarta were recruited, and a 5-point Likert scale questionnaire consisting of 19 questions was used. Kruskal–Wallis test was utilized to investigate the association of the internship nursing student confidence on PIVC insertion and maintenance with the factors. A general linear regression analysis was performed to obtain adjusted estimates of the potential factors with students’ confidence. RESULTS: Results indicated that the internship nursing student’s confidence score ranged from 57 to 95, with a mean value of 75 (±8.1). Among determinants of the student’s confidence investigated in this study, t-test analysis showed that the students’ confidence was associated with their participation in expert lecture, bedside teaching, and direct observation of procedural skill assessment of PIVC insertion and care (p < 0.05). The general linear analysis showed that only bedside teaching and interaction of bedside teaching and direct observation procedural skill assessment were significant predictors of the internship nursing student’s confidence on PIVC insertion and care (β = 10.99, 95% confidence interval [CI] 2.00–20.00 and β = 13.15, 95% CI 1.20–25.15, p < 0.05, respectively). CONCLUSION: This result indicated that nursing students need direct simulation and assessment of PIVC insertion and care to the patients to improve their confidence in PIVC insertion and management in adult patients.

Patient outlook on bedside teaching in a medical school

Objective

Bedside teaching is an important element of training undergraduate and postgraduate medical students to attain clinical skills. The perceptions of patients about bedside teaching vary significantly based on their understanding of the educational climate in hospitals. This study aimed to evaluate the views of diverse groups of patients on bedside teaching and the degree of involvement of medical students in their clinical decision-making processes.

Methods

This was a cross-sectional study conducted among patients admitted to various departments of a tertiary care hospital. A total of 200 patients were surveyed by students using a questionnaire, which covered their knowledge, views, and expectations with respect to medical students in hospital settings and bedside teaching.

Results

The majority (83.5%) of patients surveyed felt that the students made the hospital environment more comfortable and friendly. Male patients chose to permit students' involvement more than female patients. Among the female patients, teens, young adults, and unmarried women were more positive towards students' direct participation in their physical examinations. Health concerns and stress were issues for adults and older patients, whereas privacy and confidentiality concerned the younger age group. Patients admitted to the obstetrics and gynaecology wards were more likely to reject student involvement in hospital procedures than patients in other departments.

Conclusion

Most of the patients had a markedly positive attitude towards bedside teaching. Alternative methods of teaching can be implemented in situations where patients feel uncomfortable with students' involvement during their hospital stay.

Participation of medical students in patient care: How do patients perceive it?

Introduction

Clinical teaching helps students develop clinical reasoning, decision-making, professionalism, empathy, and patient management. These benefits can only be obtained if patients show reasonable acceptance towards medical students. The aim of this study was to assess patients' perceptions regarding their level of acceptance towards students' participation in their healthcare.

Methods

This descriptive cross-sectional study was conducted at King Fahd University hospital between December 2018 and March 2019. The data were collected via face-to-face interviews with patients from four clinical departments using a self-administered questionnaire. A total of 196 patients were approached for an interview, of whom 187 agreed to participate (a response rate of 95.4%).

Results

Overall, patients showed a positive attitude towards students' participation in their care. The acceptance rate was higher in cases where there was minimal or no student-patient physical contact, such as reading patient's medical records (88.8%) and attending outpatient clinics (83.3%). On the other hand, the refusal rate increased dramatically (from 11% to 43.3%) when permission was sought from patients to perform diagnostic procedures. In a comparison of specialties, the highest refusal rate was observed in the obstetrics/gynecology department, whereas the lowest refusal rate was observed in the pediatrics department.

Conclusions

Patients seeking healthcare services in a tertiary care teaching hospital have an overall positive attitude towards the involvement of undergraduate students in their medical care. The higher refusal rate with regard to students performing a physical examination and diagnostic procedures is alarming and demands alternative clinical teaching solutions, such as simulation-based training.

Aligning patient and physician views on educational pelvic examinations under anaesthesia: the medical student perspective

Recent media articles have stirred controversy over anecdotal reports of medical students practising educational pelvic examinations on women under anaesthesia without explicit consent. The understandable public outrage that followed merits a substantive response from the medical community. As medical students, we offer a unique perspective on consent for trainee involvement informed by the transitional stage we occupy between patient and physician. We start by contextualising the role of educational pelvic examinations under anaesthesia (EUAs) within general clinical skill development in medical education. Then we analyse two main barriers to achieving explicit consent for educational pelvic EUAs: ambiguity within professional guidelines on how to operationalize 'explicit consent' and divergent patient and physician perspectives on harm which prevent physicians from understanding what a reasonable patient would want to know before a procedure. To overcome these barriers, we advocate for more research on patient perspectives to empower the reasonable patient standard. Next, we call for minimum disclosure standards informed by this research and created in conjunction with students, physicians and patients to improve the informed consent process and relieve medical student moral injury caused by performing 'unconsented' educational pelvic exams.

Perceptions of patients and medical students towards each other in the setting of patient care-a South African perspective

INTRODUCTION

South Africa urgently needs more doctors. We examined perceptions of patients and students to provide evidence for optimum student-patient ratios and substantiate solutions for this dilemma.

METHODS

We interviewed 118 patients and invited 120 students to complete a self-administered questionnaire from four specialities in an academic hospital in Johannesburg.

RESULTS

The total sample size was 238 participants. A total of 91/118 (77%) patients and 78/120 (65%) students were female. Almost all the patients had some level of education, with most patients having received at least a secondary education (71/120). More than half of the students (69/120) were final year students. A third (41/118) of the patients were unaware they were admitted to a teaching hospital. Half of the patients (60/118) thought they had the right to refuse interaction with students. Patients and students preferred smaller groups of between 1-3 and 4-8 students at a bedside tutorial (p < 0.001), although patients preferred smaller groups (1-3) compared with the students (4-8). Majority of patients said they never refused consent to students, while a third of students reported at least up to three patients refusing consent to be examined. The most frequent reason cited by students for refusal of consent by patients was the exposure to excessive numbers of students and healthcare professionals.

CONCLUSION

Medical schools should consider patient safeguards while responding to the country's need for more doctors. The Medical Council and medical schools need to draw up professional guidelines on patient-student interactions, including the role of patients in this setting.