Gynae patients willing to involve med students in their care

Obstetrics and gynaecology patients in Ireland are willing to allow medical students to be involved in their care, a new study has found.

Researchers at the Royal College of Surgeons in Ireland (RCSI) and Our Lady of Lourdes Hospital in Drogheda set out to assess patient attitudes towards medical student involvement in their obstetric and gynaecology-related care.

According to the researchers, in order to acquire knowledge and develop the practical skills that a doctor requires, “it is imperative that medical students have patient contact and hands-on clinical experience”.

“For a large portion of medical school, the hospital is the classroom. However, it is important to consider how patients feel about medical student involvement, both to ensure patients feel comfortable and satisfied with their care and to ensure medical students have adequate clinical exposure.

“This balance is particularly difficult to maintain in the specialty of obstetrics and gynaecology, which is sensitive by nature,” the researchers noted.

They pointed out that a patient’s level of willingness, or a doctor’s assumption of what a patient may allow, “is often the deciding factor in whether or not a student will have a learning experience”.

While research undertaken in other countries suggests that overall, patients are willing to allow medical students to take part in their care, until now, there has been a lack of data in Ireland.

This observational study was carried out at Our Lady of Lourdes Hospital. This is a maternity teaching hospital, which records an average of more than 3,000 births, 1,400 gynaecological admissions and 1,300 gynaecolgoical procedures every year.

A total of 230 questionnaires were filled out by both inpatients and outpatients, of which 214 were satisfactorily completed and analysed.

This analysis revealed that the majority of patients are comfortable with students observing a physician during all clinical scenarios presented in the questionnaire – history taking, abdominal exam, vaginal exam, vaginal delivery and caesarean section.

When it came to the students performing these tasks themselves, just 18% of respondents said they would not allow a student to perform a vaginal exam, while 25% said they would not allow a student to perform a vaginal delivery.

Some 24% said they would be uncomfortable allowing a student to perform a vaginal exam, but they would allow a female student to do so. Some 15% said they would feel uncomfortable, but they would allow a male or female to perform such an exam.

The study also found that age appeared to play a role in how comfortable women felt around students. Those aged between 26 and 40 were much more comfortable with students observing a doctor taking a history and performing an abdominal exam than those aged 18-25.

Furthermore, those aged 40 and older were much more likely to be comfortable with a student observing a doctor performing a vaginal exam than those aged 18-25.

Meanwhile, previously giving birth did not significantly increase the likelihood of a woman being comfortable with students observing a doctor in any of the clinical scenarios described. However, women who had previously had a child were more likely to be comfortable with a student performing a vaginal delivery – 49% versus 33% of women who had not given birth previously.

The researchers said that the findings indicate that patients’ willingness to allow students to be involved in their care “may be underestimated in Irish hospitals”. They concluded that obstetric and gynaecology patients “are willing to involve medical students in their care”.

“The majority of patients involved in this study were comfortable with student involvement, whether in an observational or hands-on capacity. These results are an important guide to Irish healthcare professionals and students as they consider what level of student involvement is appropriate in clinical teaching,” they said.

However, they added that as this is the first study in Ireland to assess this issue, more research is needed “to determine how we can make advances in medical education while maintaining the highest standard of patients care and safety”.

Details of these findings are published in the Irish Medical Journal.