What do patients really think of us?

Gaining experience with real patient encounters as a medical student is an important facet of medical education that promotes the transition of learning from the classroom to clinical settings. While having students see real patients offers students a huge benefit, it’s hard to say whether patients feel just as positively about their experiences with medical students. Here in Toronto, all the major hospitals are academic and host a countless number of students from a variety of health care disciplines. Patients, as such, have become accustomed to the system of how they receive care, aka seen first by junior learners who will discuss their findings and management proposals with senior residents or staff. The environment that results from this system is usually one of reciprocal learning and gratitude. I have thus far not had any patient object to being seen by myself here in Toronto. On the other hand, as a member of the inaugural class of the Mississauga Academy, I have had patients refuse to be seen by students out in the community setting, especially since the hospitals there have just been established as teaching hospitals. When we first started clerkship, patients there were still unclear of our role and some even expressed doubts about the need for us to be there. This has changed drastically as patients become more accustomed to seeing students in the hospital.

I imagine that the process by which a trusting relationship is formed between a patient and a medical learner is not a simple one. There is a longstanding debate about whether patients should be able to choose whether to be seen by a student or not in an academic hospital/clinic setting. Some feel that students take patients for granted and may abuse their privilege to learn from patients (eg. persistently using a patient who presents with interesting pathology as a clinical model). Others feel that patients should expect to be seen by students when they step into an academic teaching hospital. While both sides have valid concerns, I feel that the best way to dissipate some of the misunderstanding is to create an environment where patients feel safe to voice their concerns to anyone of any health discipline regardless of level of training. This requires everyone’s efforts: medical education should emphasize the importance of empathy and rapport-building to produce students that are compassionate and willing to listen; senior residents, fellows and staff attending should promote their practice as an academic one and explain both their obligations as a teacher and the need for students to learn by experience. Patients also play a role here by understanding the role of a medical student and being forthcoming with their concerns so that any tensions can be addressed openly and directly.

In a study labeled “Medical students in general practice: How do patients feel?” by Cooke et al., results showed that over 50% of patients felt positively about the presence of students. Only 1% felt that the quality of the consultation was impaired, and 17% felt there to be some improvement of the interaction. This may be because more time was allocated for clinic visits when students were present, as well as patients feeling like they benefited from hearing the physician’s explanation of disease processes to students. Another study, “Phenomenological analysis of patient experiences of medical student teaching encounters” by McLachlan et al., found that patients’ perceptions of a teaching environment was affected by how the physician handled the consultation dynamics within the room. When physicians exhibited sensitive and inclusive behavior, and drew patients into a triadic relationship with them and students, patients felt appreciated and involved in the decision-making. When the triadic relationship was absent, patients felt objectified and alienated.  This conclusion supports my earlier argument that precepting physicians play an important role in creating a positive clinical environment for effective medical education to take place.

-JJ