Impact on patients of expanded, general practice based, student teaching: observational and qualitative study

doi:10.1136/bmj.38492.599606.8F

BMJ 2005;331:89 (9 July), doi:10.1136/bmj.38492.599606.8F (published 4 July 2005)

Learning in practice

Impact on patients of expanded, general practice based, student teaching: observational and qualitative study

John Benson, director, general practice education group¹, Thelma Quince, research associate, Cambridge graduate course¹, Arthur Hibble, director, postgraduate general practice education², Thomas Fanshawe, research assistant¹, Jon Emery, professor³

¹ General Practice and Primary Care Research Unit, Institute of Public Health, Cambridge CB2 2SR, ² Eastern Deanery, Cambridge CB1 5EE, ³ Discipline of General Practice, University of Western Australia, Claremont, Perth, WA 6010, Australia

Correspondence to: J Benson jab62{at}medschl.cam.ac.uk

Abstract

Objectives To compare patients' enablement and satisfactionafter teaching and non-teaching consultations. To explore patients'views about the possible impact that increased community basedteaching of student doctors in their practice may have on thedelivery of service and their attitudes towards direct involvementwith students.

Design Observational study using validated survey instruments(patient enablement index—PEI, and consultation satisfactionquestionnaire—CSQ) administered after teaching consultationsand non-teaching consultations. Ten focus groups (two from eachpractice), comprising five with patients participating in prearrangedteaching sessions and five with patients not participating inthese.

Setting Five general practices in west Suffolk and southernNorfolk, England, that teach student doctors on the Cambridgegraduate medical course.

Participants 240 patients attending teaching consultations (responserate 82%, 196 patients) and 409 patients attending non-teachingconsultations (response rate 72%, 294 patients) received surveyinstruments. Ten focus groups with a total of 34 patients participatingin prearranged teaching sessions and 20 patients not participatingin these.

Main outcome measures Scores on the patient enablement indexand consultation satisfaction questionnaire, analysed at thelevel of all patients, allowing for age, sex, general practitioner,and practice, and at the level of the individual general practitionerteacher. Qualitative analysis of focus group data.

Results Patients' enablement or satisfaction was not reducedafter teaching consultations compared with non-teaching consultations(mean difference in scores on the patient enablement index andconsultation satisfaction questionnaire with adjustment forconfounders 2.24% and 1.70%, respectively). This held true foranalysis by all patients and by general practitioner teacher.Qualitative data showed that patients generally supported theteaching of student doctors in their practice. However, thissupport was conditional on receiving sufficient informationabout reasons for doctors' absence, the characteristics of students,and the nature of teaching planned. Many patients viewed theirgeneral practice as different from hospital and expected greatercontrol over students' presence during their consultations.

Conclusions Patients' enablement and satisfaction are not impairedby students' participation in consultations. Patients generallysupport the teaching of student doctors in their general practicebut expect to be provided with sufficient information and tohave a choice about participation, so they can give informedconsent. Recognising this when organising general practice basedteaching is important.

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Rapid Responses:

Read all Rapid Responses

Interesting insights but with some omissions.: Linn M Koraen
bmj.com, 8 Jul 2005 [Full text]
Impact on patients of general practice based, student teaching.: Jan H Matthys
bmj.com, 25 Jul 2005 [Full text]