Abstract

Attitudes of students, staff and patients towards teaching medical students in the clinical environment

Author(s): Dr Alexandra Mary Higton,Dr Claire Chantry,Dr Yee Ean Ong

Introduction: Changes in medical curricula and increasing student numbers have placed increasing demand on clinicians and patients in hospital trusts. We sought to clarify which types of teaching students find helpful, what motivates staff to teach and students to attend, and whether there were sufficient willing and available patients for current student numbers.

Methods: Questionnaire surveys of medical staff, undergraduates on clinical placements and inpatients on medical wards at St George’s Hospital (UK) were conducted during October to December 2009.

Results: 112 out of 240 inpatients (47%) were willing and able to complete the survey and of these 85% were willing to discuss their medical problems and be examined by a student. Only 64% had discussed their history and 46% had been examined, leaving an “under-utilised” 33% of willing and able patients. Some patients had interacted with multiple students. Most were motivated by a desire to help students learn, and were deterred by too many requests or feeling too ill. 64% of students felt junior doctors were willing to teach and 50% felt consultants were willing to teach. Students value bedside teaching, formal tutorials and clerking acute admissions most highly, and found ward rounds and clinics least useful. They were deterred from attending by administrative issues such as timetable clashes and cancelled sessions. 85% of clinicians reported that they were keen teachers, but only 31% felt they teach as much as they wish to. Most were deterred by time constraints.

Discussion: Fewer patients are willing and available to be seen by students than might be expected. Some patients are seen by several students and a few find this burdensome, while some willing patients are not approached by medical students. The teaching modalities which students find most valuable are those which clinicians find most time-consuming as they cannot be combined with other clinical commitments. The value of teaching in clinics and on ward rounds may be improved by giving clinicians tools to teach in the busy clinical environment. Dedicated teaching time is desired by clinicians and students alike, but may not be feasible in times of financial pressures within the UK National Health Service and increasing other demands on clinicians’ time.