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LEARNING IN PRACTICE: John Benson, Thelma Quince, Arthur Hibble, Thomas Fanshawe, and Jon Emery Impact on patients of expanded, general practice based, student teaching: observational and qualitative study BMJ 2005; 331: 89 [Abstract] [Full text]

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Interesting insights but with some omissions.

Linn M Koraen   (8 July 2005)

Impact on patients of general practice based, student teaching.

Jan H Matthys   (25 July 2005)

Interesting insights but with some omissions. 8 July 2005
Linn M Koraen, Final year medical student Cambridge (CB2 2SP) Send response to journal: Re: Interesting insights but with some omissions.	As a student at the medical school where the author for correspondence works, I found it very interesting to see how patients in general practice perceived student consultations. The article was well presented although I would have found it more informative if the following had also been discussed: (a) The stage at which the participating students were at in their training. As some of the patients had expressed concerns about the students' competence, it would have been very useful to compare patients' experiences with students in the early phases to that with final year students. (b)The role of the number of students in each consultation in terms of patient satisfaction; Pairing students up may obviously be necessary for logistic reasons but if only one is present at any one time with the G.P., different satisfaction outcomes may have been obtained. (c) The role of the G.P. during the consultation; This is obviously a very important factor in determining the impact of the presence of students which the authors have not analysed in their study. Finally, although I do appreciate that a general practice setting is very different to that in hospital, after all, we are there to learn. Patients wishes and concerns are abviously paramount, but there must be a balance between this and enabling student doctors to get a true insight into general practice. Competing interests: The author is a final year student on the standard clinical course at Cambridge University
Impact on patients of general practice based, student teaching. 25 July 2005
Jan H Matthys, General practitioner, vocational trainer, University of Ghent, Belgium University of Ghent, Belgium Send response to journal: Re: Impact on patients of general practice based, student teaching.	Dear editor, An increasing amount of medical student teaching is being based in the community as it is becoming increasingly recognized that this is where most consultations take place. In their interesting article, Benson J and colleagues report about the combining of quantitative and qualitative methods in exploring the views of patients participating in teaching. In their discussion they start with the statement that participation in teaching by general practitioners and student doctors had no negative impact on patients. They come to the conclusion that patients’ enablement and satisfaction are not impaired by students’ participation in consultations. Patients generally support the teaching of student doctors in their general practice but expect to be provided with sufficient information and to have a choice about participation, so they can give informed consent.(1) Patients have always been an essential part of medical education, but we can not assume that they choose to participate. In our randomised controlled trial in 22 teaching practices, (2) we calculated the influence of the presence of doctors-in-training on the blood pressure of patients. We found that in teaching practices, the presence of a doctor-in-training has a significant pressor effect when an experienced general practitioner measures a patient’s blood pressure. We came to the following conclusions: 1. Although most patients accept that doctors in training must develop their clinical skills, the presence of a student might add to the arousal that the medical environment already imposes on a patient. 2. Blood pressure measurement may be a method to investigate whether a doctor in training when present is a neutral bystander or an obtrusive observer provoking a reactive increase in a patient’s blood pressure. 3. Our findings imply that doctors should be cautious to initiate or adjust antihypertensive treatment when blood pressure readings are obtained in the presence of a student. Your interesting article, concluding that patients’ enablement and satisfaction are not impaired by students’ participation in consultations might be an overestimation of the reality. You may argue that blood pressure measurement, arousal of the medical environment and observer effects of students have nothing to do with enablement or satisfaction, but in our ‘scientific community’ a lot of scientists feel comfortable with the ‘objective’, ‘accepted’ and ‘measurable’, ‘quantitative’ blood pressure parameters. In our study we found an influence of the presence of students on the blood pressure of patients. Enjoying your response. Dr. Jan Matthys, General practitioner,vocational trainer University of Ghent, Belgium. References 1. Benson J, Quince T, Hibble A , Fanshawe T and Emery J. Impact on patients of expanded, general practice based, student teaching: observational and qualitative study. BMJ 2005;331:89 2. Matthys J, De Meyere M, Mervielde I, Knottnerus JA, Den Hond E, Staessen J et al. Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices. J Hum Hypertens 2004;18:769-73. 3. Bentham J, Burke J, Clark J, Svoboda C, Vallance G en Yeow M. Students conducting consultations in general practice and the acceptability to patients. Medical Education 1999;33:686-7. 4. Howe A, Anderson J. Involving patients in medical education. BMJ 2003;327:326-8. 5. Cooke F, Galasko G, Ramrakha V, Richards D, Rose A , Watkins J. Medical students in general practice: how do patients feel? Br J Gen Pract.1996;46:361-2. Competing interests: None declared