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Monday, February 4, 2008

Do patients have an obligation to participate in student teaching? Why and How?

lecture university
Patients participate in teaching students in many ways. For instance during lectures. We usually choose a patient very carefully trying to find someone that may even enjoy it. Before the lecture I will explain the purpose of the lecture, the questions I will most certainly be asking and the number of students and equipment used in order to prepare the patient. At the end of the demonstration I give the patient a small token of appreciation: a cup from the university or a pen, something small but with the logo on it. After the lecture I will again talk with the patient about the experience, see whether there are questions about the lecture or anything else and thank them.

According to this article on BBC NEWS HEALTH patients must participate:

At the moment, patients have to give explicit permission before medical students are allowed to become involved in their treatment or care.

What we are trying to do is move towards a situation where the default answer from a patient is 'yes'
Professor Jim Parle, Birmingham University

The researchers said this should be replaced by a system that starts with the premise that there is no reason why students who are competent in carrying out a procedure, such as taking a blood sample, should not be doing so.

If you want patients to participate you should to my opinion fulfill the following conditions:

  • Students should train with people who are as healthy as possible before moving to more vulnerable patients, a careful selection

  • Consider some form of compensation. This could be in the sense of a small present, but there is also the question of financial compensation for these matters.

  • Provide a controlled supervised environment. If one of the students is way out of line during the interview, arrives late or is deliberately not paying attention he has a huge problem with me.

  • Consider videos, computerized systems, the use of models if possible.

  • Patients must be able to draw personal boundaries, retain privacy and consider the risks and benefits of student participation in their care.

Watch out for these adverse effects

  • Marginalization of the patient in the doctor's duties

  • Strain in the doctor patient relationship, as a patients who expects to see the doctor is instead seen by a student

  • Exposure of the patient to potential harm, discomfort and invasion of privacy.

Arguments used to justify an obligation

  • Patients may feel obliged out of simple pragmatism. Most people prefer a doctor who has learned skills in a supervised environment before they have to do it on their own.

  • Necessity of participating in teaching, research and quality assurance because without this obligation the system would collapse. But the system could be set up in many different ways not always needing the participation of patients.

  • If a student learns the procedure with a patient, then both the patient and future patients will benefit.

  • Communitarian argument that as we all benefit from the presence of a medical system, we should all be prepared to contribute to it.

  • Statements as: "well it is a teaching hospital after all", are used to justify the notion that those who use the public hospital get something for nothing

There is no a convincing argument that patients have an obligation to participate in medical teaching.
The challenge for educators is to develop an authentic process of consent whereby the risk of student participation are acknowledged but contained, and whereby patient altruism is encouraged but not assumed

Patients don't have an obligation they participate out of altruism.

Article used:
Med Educ. 2008 Jan 24 [Epub ahead of print]
Do patients have an obligation to participate in student teaching?
Lowe M, Kerridge I, McPhee J, Hart C.
PMID: 18221270


Aqua said...

I remember one instance where I was at a teaching hospital and it was a nightmare. I was to see a gynecologist (sp??) and the nurse had me prepped, legs in the sturrups waiting for the Dr. He came in and behind him were six or seven medical students. The Dr asked me THEN if it was okay for them to come in.

He had no idea of my psychiatric history, that I have an impossible time saying no to authority figures, that I was overwhelmed with feelings of shame and fear and scared to death of one man, let alone a slew of people viewing my private parts.

I'm not even sure a woman who was mentally healthy would find it easy to say no as a group walked in. It was so traumatic for me. To this day I cry when I think of it.

I agree that patients interacton and participation is important, but a private consultation is neccesary to prepare the patient (which you mentioned). Good post.

Dr. Shock said...

Now that you mention this I can't remember being told how to ask patients or how to prepare them for participation in education. In my time the specialists in those days weren't very good examples to follow when it comes to speaking with patients at lectures or other situations.
Regards Dr Shock