|ORIGINAL RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 3 | Page : 210-216
Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria
Philip Babatunde Adebayo1, Stephen Olabode Asaolu1, Adeolu Oladayo Akinboro1, Adeseye Abiodun Akintunde1, Olawale Adebayo Olakulehin2, Olugbenga Edward Ayodele1
1 Department of Medicine, Ladoke Akintola University of Technology and Teaching Hospital, Ogbomoso, Oyo State, Nigeria
2 Department of Surgery, Ladoke Akintola University of Technology and Teaching Hospital, Ogbomoso, Oyo State, Nigeria
|Date of Web Publication||11-Apr-2017|
Philip Babatunde Adebayo
Department of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, PMB 4000, Ogbomoso, Oyo State
Source of Support: None, Conflict of Interest: None
Background: This study aimed to evaluate how patients feel about the introduction of medical students into a former general hospital transformed to a teaching hospital in southwestern Nigeria and to also assess the extent to which they are willing to involve medical students in the management of their conditions. Methods: In a descriptive cross-sectional study, a sample of 251 randomly selected patients were interviewed using a pretested questionnaire that assessed patients' demography, patients' acceptance of and reaction to the involvement of medical students in their clinical care including the specific procedures the patients would allow medical students to perform. Results: Two hundred and fifty-one patients with mean age ± standard deviation of 37.33 ± 19.01 (age range = 16–120 years; M:F = 1:1.26) were recruited between January 01 and March 31, 2013. Most patients (86.5%) preferred to be treated in a teaching hospital and were comfortable with medical students as observers (83.7%) and serving as the doctors' assistant (83.3%) during common diagnostic procedures. Men were more willing to have invasive procedures such as insertion of urinary catheter (56.6% vs. 43.4%, P = 0.001). Acceptability of medical students (such as willingness of patients to have students read their medical notes) was significantly higher in nonsurgical specialties than in surgical specialties (77.5% vs. 22.5%, P< 0.001). Factors associated with a positive disposition include age >40 years, male gender, and higher level of education as well as consultation in nonsurgical specialties (P = 0.001). Discussion: Medical students are well received into this new teaching hospital setting. However, there is a need for more education of younger, less educated female patients of surgical subspecialties so that they can understand their importance as irreplaceable partners in the training of medical students.
Keywords: Education, medical faculty, Nigeria, Patients' disposition, receptiveness
|How to cite this article:|
Adebayo PB, Asaolu SO, Akinboro AO, Akintunde AA, Olakulehin OA, Ayodele OE. Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria. Educ Health 2016;29:210-6
|How to cite this URL:|
Adebayo PB, Asaolu SO, Akinboro AO, Akintunde AA, Olakulehin OA, Ayodele OE. Patients' feelings about the presence of medical students in a New Teaching Hospital in Southwestern Nigeria. Educ Health [serial online] 2016 [cited 2022 Jan 17];29:210-6. Available from: https://www.educationforhealth.net/text.asp?2016/29/3/210/204222
| Background|| |
Bedside teaching is the traditional model of clinical education for medical students. Four factors pivotal to optimal bedside teaching remain: a robust and well-planned teaching curriculum, well-trained clinical tutors, medical students who are keen to learn and develop their clinical skills, and patients who allow students to learn and gain experience through them. Since university hospitals have a more diverse group of patients with different illnesses, it is both practical and logical for medical students to have clinical education in teaching hospitals. The vital role that patients serve in the training of medical students has not been given much consideration in some parts of the world. Studies from developed and some low- and middle-income countries have shown that patients are generally willing partners in the training of medical students.,,, The continuity of patient's choice to participate in medical education has been a major concern nevertheless. In sub-Saharan Africa, however, there is a scarcity of literature on patients' perception of medical students and their presence in the course of care. It becomes important to pay close attention to the patients' feelings and responses toward the presence of medical students because patients should determine to what extent they are willing to share their privacy with medical students in attendance.,
In May 2011, the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria, was inaugurated to be an additional teaching hospital of the medical faculty of LAUTECH, whose main teaching hospital is in Osogbo, a city located about 57 km from the new facility. To ensure proximity of this new facility to the populace of Ogbomoso, the former general hospital was upgraded and converted to the new teaching hospital. This practice is not unusual as the teaching hospital in Osogbo was also an upgraded and converted general hospital. The assumption of this study is that in a former general practice that is transformed into a teaching hospital, there are tendencies for the patients' confidence, expectations, and satisfaction as well as accessibility of services to increase as a result of the introduction of medical students in the consulting rooms, ward rounds, and operation theaters of the hospital.
The present study aimed to assess how patients felt about the introduction of medical students into a former general practice and also to assess the extent to which they are willing to interact with and involve medical students in the management of their conditions.
| Methods|| |
Study design and participants
This was a cross-sectional descriptive study carried out in the new LAUTECH teaching hospital, Ogbomoso, Nigeria. This newly upgraded facility was a general hospital that served the semi-urban settlement of Ogbomoso and its surrounding towns and villages in Oyo state, south-western Nigeria. The participants of this study were patients randomly selected by balloting. Patients were eligible for interview if they picked “yes” from a small ballot box after they have been informed of the purpose of the study (the box contained several “yes” and “no” ballots). Patients were free to decline being interviewed even if they chose “yes” from the ballot box. The patients were interviewed at the outpatient clinics of the following departments: Internal medicine, Surgery, Obstetrics and Gynaecology, and General Outpatients' Departments (GOPD) during the study period (January 01–March 31, 2013). Pediatric patients were excluded from the study because of their inability to fully understand all the dimensions in the questionnaire, and we did not want a proxy response. Psychiatric patients were also excluded from the study.
Data collection tools and activities
A 23-item questionnaire was structured and modeled after similar studies. In the first question, patients were asked whether they preferred to be treated in a teaching hospital or a nonteaching hospital. The rest of the questionnaire was made up of three sections (with 22 questions). The first section contained questions about sociodemographic data that included age, gender, the specialty clinic where patients were interviewed, ethnicity, educational level, marital status, employment status, occupation, and religion. The second section examined issues related to the patients' acceptance; reaction to and permission of medical students in the clinics, wards, and operation theaters of the hospital, with allowable responses of yes, no, and not sure. The third section asked which specific procedures patients would allow medical students to perform, with yes or no as the two options. The questionnaire was pretested for clarity among five patients in the Medicine department, and no changes for ambiguities or other reasons were made to the final draft. The questionnaire was administered in the respective departments of the hospital to the patients by one of the investigators (SOA). Every patient who attended the clinics from Monday to Thursday during the study period was approached. Patronage of the clinics was low during the study period (the teaching hospital just became operational) and hence, it took a while before we could conclude recruitment of the patients. A total of 407 patients were approached, of which 251 were eligible for interview. All the 251 patients participated in the survey.
Ethical approval for the study was received from the Health Research and Ethics Committee of the hospital. Informed written consent was received from each participant before the interview.
Data were analyzed using the Statistical Package for Social Sciences software (version 20, Chicago, IL, USA). The data were analyzed using both descriptive and analytical statistics. Sociodemographic variables were cross-tabulated with different items assessing patients' disposition to medical students on the questionnaires. Chi-square test was used to determine the differences in proportions. Level of statistical significance was set at P< 0.05.
| Results|| |
Characteristics of the participants
The participation rate was 100% with females being slightly more than males (55.8% vs. 44.2%). The mean age ± standard deviation was 37.3 ± 19.01 years (median: 30.0, range = 16–120 years) with 63% being <41 years old. Of the 251 participants, 59.8% were married, 51.4% were currently employed, and 32.3% were students. Majority were Muslims (70.55%), of Yoruba ethnic group (98.8%), and had tertiary education (72.5%). The other characteristics of the study population are presented in [Table 1].
Patients' view on medical students
[Table 2] shows the patients' disposition to the presence of medical students in specific areas of hospital practice. Two hundred and seven (86.5%) patients preferred to be treated in a teaching hospital instead of a nonteaching hospital, while 207 (82.5%) patients would allow students to go through their medical files. Most (211, 84.1%) patients would allow medical students take their medical history and details in the presence of a medical doctor.
|Table 2: Patients' reaction to the presence of medical students Reaction to the presence of medical students in the teaching hospital|
Click here to view
Participants in the age group of 25–40 years were the less receptive compared to those below 25 and above 40 years. Patients in the Obstetrics and Gynaecology (O and G) department (who are all females) were the least receptive as only 51.1% would allow medical students to be present in the operation room if they were having surgery. [Table 3] shows the association of sociodemographic parameters to patients' disposition.
|Table 3: Association of patients' reaction to the presence of medical students with sociodemographic parameters|
Click here to view
Specific procedure allowed
[Table 4] shows the relationship between sociodemographic status and the specific procedures. Men were more willing to have their abdomen palpated (P = 0.001), allow urinary catheterization (P = 0.001), as well as a rectal examination (P = 0.001), while more women would allow chest examination compared to men (P < 0.001). The rest of the results are shown in [Table 4].
|Table 4: Relationship between specific procedures allowed and sociodemographics|
Click here to view
| Discussion|| |
Our study showed that patients attending LAUTECH Teaching hospital, Ogbomoso, are generally favorably disposed to the presence of medical students in the hospital and a significant proportion of the respondents would prefer treatment in the teaching hospital setting. This finding confirms reports from previous studies reporting that patients are positively disposed toward the presence of medical students in teaching hospitals across Middle Eastern, European, and other countries., 5, ,,,, The reasons attributed to positive patients' disposition to medical students in literature include altruism; sense of contributing to medical students' education, giving back to society, or helping someone. While others believe that the presence of medical students allows for better understanding of their disease condition, allows for second opinion, provides detail examination, and improve the quality of their interaction with consultants., 10, ,,, For women in labor, medical students are seen as intrapartum emotional supporter, and people who had their relations admitted in the Intensive Care Unit preferred students' presence.
Patients' positive disposition to medical student participation in care varied widely in our study from 44.6% to 88.8%. The variation is contingent upon patient-, student-, and consultation-related factors. Patients' consent was lowest with active and educational participation that bordered on intrusion on privacy such as intrusive physical examination and invasive procedures and highest with passive participation such as students' presence in the clinics and ward rounds. The perception of inexperience and risk of complications could have influenced patients' aversion to medical students' performance of invasive procedure. Another possible reason is the fact that some of these procedures are painful, and if performed by medical students, it may provoke more pain and take a longer time than if performed by trained doctors. Emotional factors such as depression or anxiety have been attributed to patients' rejection of medical students., In this regard, acceptance of medical students by patients could be improved by patient education before consultation as well as a gentle approach to obtaining patients' consent.,,
Sociodemographical factors such as race, gender, marital status, religion, occupation, family income, and specialty of the practice are known to influence the disposition of patients to medical students. Our study showed that patients who were above the age of 40 years were more favorably disposed to medical students with regard to communications and specific procedures. This finding is similar to that of Sweeney  and Marwan et al. These authors equally found that 83.9% of the patients interviewed in their study (age ≥41 years) permitted medical students to take their medical history with the presence of a doctor. Our participants who have tertiary education were more willing to allow medical students to take history and personal details in the absence of a medical doctor like in other studies., We do not have a ready explanation for this observation, but we would like to postulate that a sense of altruism is most likely higher among the highly educated patients.
Although the level of preference for teaching hospital care seems higher among females than males, more males were favorably disposed to body-exposing examinations and invasive procedures compared to females as in other studies., Female participants felt more uncomfortable with procedures around the genital area than the males. The fact that there were more Muslim female participants in our study could have accounted for this finding. In contrast to our study, however, Law et al. found no gender difference with respect to clinical teaching and acceptability of patients in rural Canada. Cultural factors could have influenced this outlook; for example, Yoruba females are expected to be very discreet about body exposure.
With respect to departments or specialties, patients attending consultation with the nonsurgical departments of Medicine and GOPD were more positively disposed to students compared to those attending the surgical specialty clinics of Obstetrics and Gynaecology and Surgery. These findings may not be unconnected with the level of student involvement in each department. Patients are open to students' involvement in nonsurgical specialties that probably involves less intrusion on privacy in examinations and procedures. Magrane et al. observed that obstetric patients in labor are mostly concerned about privacy and their decisions to accept or reject students were premised on previous experience. Although giving utmost respect to patients' privacy has always been emphasized in clinical examinations, perhaps, this is more imperative in the surgical-related subspecialties.
Limitations of the present study include lopsided selection of patients that favored nonsurgical specialties; hence, data relating to surgical subspecialties must be interpreted with caution. The study was restricted to one hospital; hence, sample used may not be representative of the feeling of people in Ogbomoso toward medical students.
| Conclusion|| |
Our study confirms that patients' disposition to medical students in a new teaching hospital in Nigeria is favorable. However, there are areas of restrictions as students are less favorably accepted in certain clinical settings. Patients seemed uncomfortable with body exposure in physical examinations and invasive procedures. Receptiveness seems reduced in surgical-related specialties compared to nonsurgical. Factors associated with positive disposition include age >40 years, male gender, higher level of education, religion, and consultation in nonsurgical specialties. There is a need for patient education on their importance as irreplaceable partners in the training of medical students, which will translate to more supply of well-trained doctors (in knowledge, ethics, and character) and ultimately good health outcomes for the nation in the future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Marwan Y, Al-Saddique M, Hassan A, Karim J, Al-Saleh M. Are medical students accepted by patients in teaching hospitals? Med Educ Online 2012;17:17172.
Oswald N. Where should we train doctors in the future? BMJ 1991;303:71.
Abdulghani HM, Al-Rukban MO, Ahmad SS. Patient attitudes towards medical students in Riyadh, Saudi Arabia. Educ Health (Abingdon) 2008;21:69.
Bishop F, Matthews FJ, Probert CS, Billett J, Battcock T, Frisby SD, et al.
Patients' views on how to run hospital outpatient clinics. J R Soc Med 1991;84:522-3.
O'Flynn N, Spencer J, Jones R. Does teaching during a general practice consultation affect patient care? Br J Gen Pract 1999;49:7-9.
Sousa Ade C, Tajra Cda R, Coelho Rde S, Gomes CM, Teixeira RA. Medical learning in a private hospital: Patients' and companions' perspectives. Sao Paulo Med J 2009;127:101-4.
Howe A, Anderson J. Involving patients in medical education. BMJ 2003;327:326-8.
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.
Sweeney K, Magin P, Pond D. Patient attitudes – Training students in general practice. Aust Fam Physician 2010;39:676-82.
Mol SS, Peelen JH, Kuyvenhoven MM. Patients' views on student participation in general practice consultations: A comprehensive review. Med Teach 2011;33:e397-400.
Hudson JN, Weston KM, Farmer EE, Ivers RG, Pearson RW. Are patients willing participants in the new wave of community-based medical education in regional and rural Australia? Med J Aust 2010;192:150-3.
Law M, Hamilton M, Bridge E, Brown A, Greenway M, Stobbe K. The effect of clinical teaching on patient satisfaction in rural and community settings. Can J Rural Med 2014;19:57-62.
Bentham J, Burke J, Clark J, Svoboda C, Vallance G, Yeow M. Students conducting consultations in general practice and the acceptability to patients. Med Educ 1999;33:686-7.
O'Flynn N, Spencer J, Jones R. Consent and confidentiality in teaching in general practice: Survey of patients' views on presence of students. BMJ 1997;315:1142.
Magrane D, Gannon J, Miller CT. Obstetric patients who refuse and those who select medical student participation in their care. Acad Med 1994;69:1004-6.
Sayed-Hassan RM, Bashour HN, Koudsi AY. Patient attitudes towards medical students at Damascus University teaching hospitals. BMC Med Educ 2012;12:13.
Salisbury K, Farmer EA, Vnuk A. Patients' views on the training of medical students in Australian general practice settings. Aust Fam Physician 2004;33:281-3.
Tang TS, Skye EP. Who gets “kicked out” of the exam room? Factors associated with patients declining medical student participation. Teach Learn Med 2009;21:1-7.
[Table 1], [Table 2], [Table 3], [Table 4]