Using student doctor or trainee doctor may be helpful
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7423.1110-a (Published 06 November 2003) Cite this as: BMJ 2003;327:1110
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
In contrast to the experiences of Mr Peacock, I have found that
introducing myself as "student doctor" is more helpful than using "medical
student", especially for male students on their obstetrics &
gynaecology attachments. Also I have heard some doctors employing the
former term when introducing medical students, perhaps because they think
it generates less anxiety for patients (which is certainly my
observation).
Competing interests:
None declared
Competing interests: No competing interests
Points:
Regarding the assumptions of the “correspondent from Scotland” to
which Ms McCabe refers – I merely give the example of my recent experience
in general practice. I am aware that this does not reflect the experience
of a number of my colleagues in the same setting.
Further, I would not say that the consent process to which I refer is
at the same level as the completion of a consent form. Is this really
necessary, though, for the vast majority of situations in which patients
are involved in medical education? Medical students HAVE to learn and this
would be IMPOSSIBLE without the involvement of patients. I would be very
interested to hear the views of patients on the level of consent they feel
is appropriate to their participation in medical training – both
undergraduate and postgraduate.
The issue of access to medical records by students and numerous other
healthcare workers, including non-clinical workers, is extremely
interesting and one to which I imagine many patients have not given
detailed consideration. Perhaps a fuller explanation to patients of how
and why their medical records may be used by students and others is a job
for trusts and other healthcare organisations?
In defence of medical students:
Not only do we have to learn, but we undoubtedly do some of the work
of hospitals. We also may affect the management of patients via the
questions we ask or the points we uncover in the history – which we often
have more time to take. At the very least, we usually have more time to
stop and talk with our patients, and I am sure most of them prefer this to
spending yet more time staring at the same four walls.
Finally, medical students can be subject to fitness to practise
proceedings by their medical schools, as qualified doctors can be subject
to such proceedings by the GMC. Whatever the ethical rights and wrongs of
patient participation in medical education, the rights of patients are
being protected in this way by medical schools. And I hope the privilege
we have in learning medicine is fully appreciated by all medical students.
Competing interests:
None declared
Competing interests: No competing interests
There is still too much variation in practice. Some GPs ask a person
out of the blue, eg, in the corridor as they are going in, if they mind a
student sitting in, or even when they are already in the room and find
student sitting there having already been given access to their file and
been discussed by the GP, so putting both less assertive persons in an
embarrassing dilema and certainly one where s/he has not given proper
consent. Others, but perhaps more rarely than your correspondent from
Scotland assumes, have started to use a consent form. The one introduced
recently by one of the more forward thinking medical schools,the
PENINSULAR MEDICAL SCHOOL for use in surgeries in their area is very
easily copied. The MENTAL HEALTH AND SOCIAL CARE TRUST IN CAMDEN is
providing specific advice and training for GPs around issues of consent
to use of information.
People do also have the right to put their wishes on file but again
it requires that they are informed enough to realize the need to do so.
It is not acceptable that again people are offered best practice in some
areas but denied it in others. In some areas students are encouraged to
seek placements in surgeries carrying out research or 'innovative
work' which means using more than the more usual level of sensitive
information. There needs to be proof of consent in writing, students and
other health workers do not live in different worlds from those they learn
from.
For example, I wonder how one student from the Royal Free is getting on - he
poked his head into the room of a woman who had had an hysterectomy the
day before - stating '(I) am a medical student, (no name) can I ask you a
few questions? (He already had the woman's file in his hand and had read
it). His only question was 'So you don't have any trouble with sex then?'
He then scuttled out of the room. Was this a set up, was it his own
crassness, where was the input from a trainer, why are people not asked
their opinion of the students' contribution? OK this is a bad one but it
happens. An elderly lady had had two glaucoma operations, then two
operations for cataracts, she can hardly walk as she is in such pain, could
hardly see but nevertheless was willing to talk with a student. Her first
quetion? 'Why are you wearing odd socks?' There are many great students in
the system but some seem to learn too easily how to exploit rather than
respect vulnerability.
Fairly soon there will also be a form produced which gives the same
protection to persons using clinics in Acute Trusts
People likely to benefit from this are those who are most easily denied
their rights by not knowing how the system works.
Sadly students as well as trainers do breach confidentiality, so that
a proforma helps to embed a culture which highlights obligations and
consequences of breach of persons' rights.
Competing interests:
None declared
Competing interests: No competing interests
I was interested to read Hany George El-Sayeh's views on medical
students in hospital. The author writes that the presence of students is
more welcome when referred to as 'student doctors' rather than given the
traditional title of 'medical student'. During my time on the wards and in
general practice, I have not found this to be the case. Although my ID
badge displays the title 'Student Doctor', I always introduce myself as a
medical student, and have found that doctors I have been working with have
done the same. I have not come across any prejudices from patients because
of this title, and do not believe that use of the title 'Student Doctor'
does, or should, make any difference.
I fully agree with El-Sayeh that dress code is important, and this
was addressed by the University from the start of the first year. Myself
and my student colleagues always try to dress in a professional and
appropriate way, and have found that patients are happy to help us to
learn. I would interested to see if any patients do expect a 'scruffy,
disinterested youth' when they hear the term medical student anymore than
if told there will be a student doctor present.
Perhaps this has highlighted an interesting area for research?
However, for now I will continue to call myself a medical student, and try
to gain patients' trust by my attitudes and appearance, rather than by my
title.
Competing interests:
None declared
Competing interests: No competing interests
As a medical student, I welcome the debate regarding the
participation of patients in medical education. This participation is
clearly essential and I would hope that patients appreciate this as much I
appreciate their facilitation of my clinical learning. But this
participation must not be without appropriate consent, and El-Sayeh raises
some interesting issues regarding obtaining that consent.
The lack of advance consent from patients for the presence of a
medical student during hospital clinics noted by El-Sayeh reflects my own
experience of hospital clinics, but contrasts with my recent experience of
general practice. When I was sitting in with one of the GPs, patients
would be given a chit by the receptionist on their arrival, telling them
that a medical student was sitting in and that if they objected to this to
inform the receptionist. This would then be noted on the computer system,
so I could leave the consulting room before the patient was called
through. The GP would also check verbally that the patient did not mind my
presence before introducing me.
Maybe this system partially reflects the different relationship GPs
have with their patients, as well as the differences of the general
practice and teaching hospital settings. In the latter, there seems to be
more of an implicit assumption that students will be accepted, despite the
likelihood that many patients do not fully appreciate what being a
teaching hospital really means and that they probably had little choice
other than to be admitted to a teaching hospital.
On El-Sayeh's other point, I wonder if there is any evidence that
introducing medical students as "student doctors" increases the likelihood
of patients accepting their presence in consultations? I think it would be
unlikely that the use of the title "student doctor" rather than "medical
student" would really impact on any (unfortunate and hopefully
unwarranted) fear by patients "...that they will be seen by a scruffy,
disinterested youth who may well later report their intimacies in the
bar."
I further think the term "trainee doctor" is a confusing and
potentially misleading one, as in Medicine "trainee" usually refers to a
junior doctor. It is unlikely that most patients fully understand the
medical hierarchy, however, and so such subtleties, as with all potential
titles for medical students, would surely be lost on many patients.
Competing interests:
None declared
Competing interests: No competing interests
Not doctors yet
In common with other medical students, I have found patient consent
and student identification to be difficult issues.
Firstly, I have found most institutions take an informal attitude to
patient consent. In many cases I have been sitting in the consultation
room while the patient is wheeled in, obviously unaware a student would be
there. In theatre sessions, consent would be sought I was present in the
anaesthetic room but not if I was present only in the theatre proper
(apparently on the principle "what the patient doesn't see, they're not
going to mind"). This contrasts sharply with the robust procedures at the
general practice described by Deborah White.
Secondly, I wish to pick up on El-Sayeh's point on the labels used
for medical students. I believe the terms "student doctor" and "trainee
doctors" are misleading on two counts. Most importantly, patients may
conclude that a student doctor is a type of doctor rather than a type of
student - perhaps accounting for the difference in attitudes noted by El-
Sayeh. Also, I believe the word "trainee" is unhelpful because it could
aptly describe doctors in any stage of training from new house officers to
specialist registrars.
Competing interests:
None declared
Competing interests: No competing interests