Would you consent to being examined by a medical student? Western Australian general public survey

Abstract

Background: Patients generally have positive attitudes regarding being examined by a supervised medical student as part of their medical care. However, it is difficult to obtain model patients for students to examine purely for teaching purposes (i.e. in the absence of medical treatment).

Aims: This study explored the effects of participants’ demographics, characteristics of medical students, and the type of examination/procedure on whether individuals would consent to be examined by a medical student purely for teaching purposes.

Method: Four-hundred-and-two Western Australians completed an online survey in 2009.

Results: Individuals were generally unconcerned regarding a medical student's gender and ethnicity. However, they would either not permit or wanted more advanced medical students to examine more intimate body regions and conduct more invasive procedures. Less observing medical students were permitted to be present for intimate examinations. Individuals who were male, aged ≥25 years, Caucasian, and of no religious affiliation were more likely to permit formative year medical students to examine and conduct procedures on them. Additionally, these individuals were more likely to have had prior experience with a medical student and/or been hospitalised previously.

Conclusions: This information may be useful in terms of recruiting patient models for teaching purposes.

Introduction

Peer physical examinations, which involve medical students examining each other, are commonly used by medical schools around the world. Such examinations are generally accepted by most students for non-intimate body regions (e.g. O’Neill et al. 1998; Rees et al. 2009). However, there are a few students who are reluctant to participate in such activities and thus students’ attitudes towards such examinations have received considerable attention over the past decade (Barnette et al. 2000; Braunack-Mayer 2001; Chang & Power 2000; Das et al. 1998; O’Neill et al. 1998; Outram & Nair 2008; Power & Center 2005; Rees 2007; Rees et al. 2004, 2005, 2007; Wearn & Bhoopatka, 2006; Wearn & Vnuk 2005). These studies have shown that students who were female (Chang & Power 2000; O’Neill et al. 1998; Power & Center 2005; Rees et al. 2004, 2005, 2007), were affiliated to a religion (Rees et al. 2005, 2007; but see also Rees et al. 2004) and were non-Caucasian (Rees et al. 2007) were more reluctant to participate in peer physical examinations.

From a patient perspective, there is evidence to suggest that patients generally have a very positive attitude towards being examined by medical students including while hospitalised (York et al. 1995) or attending a general practice (Prislin et al. 2001). Patients are also comfortable with medical students being present while attending an obstetrics-gynaecology clinic (Hartz & Beal 2000), but are less favourable towards having a medical student present while attending a sexual health clinic (Ryder et al. 2005). However, patients are reluctant to be a medical student's first patient in an emergency department especially for invasive procedures (Graber et al. 2003). Male medical students at a general practice were more likely to encounter female patients objecting to their presence than female students (Kljakovic & Parkin 2002). Once receiving medical student care within a hospital setting patients are likely to volunteer for future medical student participation (York et al. 1995). Although these studies show that patients have positive attitudes towards medical students, they are restricted to situations where patients are attending with the intent of seeking medical care as opposed to attending purely for teaching purposes. Thus to the best of our knowledge, little, if anything, is known regarding patients’ perceptions towards being examined by medical students purely for teaching purposes (i.e. in the absence of medical treatment).

At The University of Western Australia (UWA), model patients with real medical problems and simulated patients are recruited from the general public to be examined by supervised medical students for teaching purposes in a clinical setting. However, the response rate to patient recruitment adverts has been inadequate to provide an optimal number of patients.

The broad aim of this study, which was part of a larger study, was to establish the general public's perceptions regarding being examined by medical students purely for teaching purposes.

Method

Participants

Participants, with a minimum age of 18 years, were recruited via an e-mail notice sent to UWA staff and students, two advertisements in a weekly community newspaper within the northern suburbs of Perth, advertisement posters at 27 Western Australian libraries (rural and urban), a local shop, a staff noticeboard at a suburban school and via word of mouth. The adverts directed participants to an anonymous online survey regarding their perceptions of being examined by a medical student.

Procedure

Ethical approval for this study was obtained from the Human Research Ethics Committee at UWA. The survey was pilot tested by staff and postgraduate students within the Discipline of General Practice and the School of Anatomy and Human Biology (both at UWA) on three separate occasions. Survey revisions were made after each pilot study. Pilot participants were asked to comment on the clarity of questions, typographical errors and to suggest changes that would capture factors that would determine whether they would permit a medical student to examine them. Based on this feedback, it was established that the level of study, gender and ethnicity of a medical student may contribute to whether an individual would permit a medical student to examine them. It was also established that individuals may be concerned in regard to the number of observing medical students present for certain examinations.

The first page of the final online survey explained the purpose of the study to participants and obtained participants’ consent. All participants had the option to enter a draw for a chance to win one of ten $50 cheques. Information obtained for the draw could not be linked to the survey.

Prior to participants being asked any questions pertaining to examinations/procedures conducted by medical students, they were given a brief description as to what is meant by ‘examinations/procedures conducted by medical students’. Examinations/procedures conducted by medical students was defined as follows: ‘(a) the medical student is fully supervised by a qualified clinician at all times; (b) the situation is managed in a professional way; (c) examinations/procedures take place in a clinical setting (i.e. a clinical skills teaching facility on the university campus) unless stated otherwise and (d) up to 15 medical students (unless stated otherwise), with one student examining at a time, and the clinician is present’.

At the start of the survey, participants were asked questions in regards to their gender, age, ethnicity, religious affiliation, prior medical student examinations and the total number of days that they have ever been hospitalised. Participants were asked to indicate the minimum year level of medical training (first-, second-, third-, fourth-, fifth-, sixth-year, would not permit), a student must be in, in order to permit an examination of each of the following body parts (adapted from: O’Neil et al. 1998; Rees et al. 2004): head and neck, hand, arm and shoulder, upper body (no breast exposure), abdomen, back, groin, genitals, feet and legs, and hips. Those who did not permit a medical student to examine the specified body part were asked to provide a reason. Participants who permitted the examination were asked to indicate which option best described them regarding the type of medical student that they would permit to examine them (Gender: same, opposite, either; Ethnicity: same, different, any) and the maximum number of observing medical students they would permit to be present (14, 11, six, two, none). The same set of questions as those asked for the body parts was then asked for each of the following medical procedures: blood pressure measure, blood test, breast examination (women only), digital rectal exam, ear examination, electrocardiogram, eye examination, injection in the arm, insertion of a urinary catheter, insertion of an intravenous drip, listening to the chest, oral temperature measure, pap smear (women only) and testicular examination (men only). Given that the general public may be unfamiliar with the terms ‘digital rectal exam’ and ‘electrocardiogram’, a brief description of each was provided the first time the term was used. Digital rectal examination was described as ‘inserting the finger into the anus’ and electrocardiogram was described as ‘a painless procedure involving the attachment of skin electrodes to measure the heart's electrical activity’. At the end of the survey, free comments were encouraged.

Results

Four-hundred-and-two participants completed at least one survey question whereas 339 participants completed the entire survey. Twice as many females than males took part in the study (Male: N = 134; Female: N = 268). Participants had a mean age of 27.7 years (N = 399, SD = 12.1, range = 18–76). Two-hundred-and-forty-five participants entered the draw.

Student's level of study, body regions and medical procedures

In the study, participants indicated that they would be reluctant to permit examination of the genitals by a medical student. This is reflected by the high frequency of participants who would refuse to have their genitals examined by a medical student (Figure 1). In general, the further the body parts were away from intimate body regions (e.g. genitals), the more likely individuals were to permit less advanced medical students to examine them. In regards to the groin region, individual's permission to examine this area was approximately equally distributed across student's levels of study. Overall, participants would permit all year levels of students to examine all body regions with the exception of the groin and genitals (Figure 1).

Figure 1. Frequency of responses indicating the minimum year of study a medical student must be undertaking in order for a participant to permit an examination of a specified body region.

For six of the 14 procedures, the most frequent response was that participants would permit first-year medical students to perform the procedure specified (Figure 2). This was particularly so for the non-invasive procedures (e.g. measuring blood pressure). On the other hand, not permitting a medical student to perform the procedure was the most frequent response for the following procedures: breast examination, digital rectal examination, insertion of a urinary catheter, a pap smear and a testicular examination.

Figure 2. Frequency of responses indicating the minimum year of study a medical student must be undertaking in order for a participant to permit the specified medical procedure to be performed.

Student's gender, body regions and medical procedures

The majority of participants indicated that they would permit a medical student of either gender to examine each body region (Abdomen: 81.7%; Arm and shoulder: 97.1%; Back: 91.4%; Feet and legs: 94.2%; Genitals: 61.4%; Groin: 59.7%; Hand: 98.0%; Head and neck: 96.9%; Hips: 83.2%; Upper body: 80.4%). Similar to the body regions, the most frequent response for all procedures, with the exception of the breast examination and the pap smear, was that participants would permit a medical student of either gender to perform the procedure (Blood pressure: 98.2%; Blood test: 98.1%; Digital rectal exam: 72.3%; Ear exam: 98.8%; ECG: 91.8%; Eye exam: 98.8%; Injection in arm: 98.6%; Insert urinary catheter: 69.6%; Insert IV drip: 98.2%; Listen to chest: 93.4%; Oral temperature: 97.3%: Testicular exam: 80.6%). More than half of the women indicated that they would only permit a female medical student perform a breast examination (52.8%) and a pap smear (57.4%).

Student's ethnicity, body regions and medical procedures

The majority of participants indicated that they would permit a medical student of any ethnicity to examine each body part (Abdomen: 96.5%; Arm and shoulder: 97.4%; Back: 97.9%; Feet and legs: 97.1%; Genitals: 91.8%; Groin: 94.5%; Hand: 99.4%; Head and neck: 98.3%; Hips: 95.6%; Upper body: 95.9%) and to perform each procedure (Blood pressure: 98.5%; Blood test: 96.8%; Breast exam: 94.3%; Digital rectal exam: 94.6%; Ear exam: 96.2%; ECG: 96.7%; Eye exam: 98.4%; Injection in arm: 96.2%; Insert urinary catheter: 95.2%; Insert IV drip: 96.3%; Listen to chest: 97.3%; Oral temperature: 97.3%: Pap smear: 93.8%; Testicular exam: 95.8%).

Number of observing students, body regions and medical procedures

For examinations pertaining to eight of the ten body regions (Figure 3), the most frequent response given by participants was that they would permit 14 observing medical students to be present (i.e. one medical student performing the examination, one clinical supervisor and 14 observing medical students). The less intimate the body regions (e.g. the hand), the more participants responded that they would permit 14 observing medical students to be present. For the groin and genitals the most frequent responses were that two or no observing medical students would be permitted, respectively.

Figure 3. Frequency of the number of participants permitting a maximum of 14, 11, six, two and zero observing medical students to be present while being examined by a supervised medical student for each of the specified body regions.

For the procedures involving intimate areas of the body (e.g. breast examination, digital rectal examination), the most frequent response was not allowing observing medical students to be present (Figure 4). On the other hand, the most frequent response for all remaining procedures was having 14 observing medical students present.

Figure 4. Frequency of the number of participants permitting a maximum of 14, 11, six, two and zero observing medical students to be present while being examined by a supervised medical student for each of the specified medical procedures.

Participant demographics, student's level of study and number of observing students

Given that level of study and number of observing students permitted varied across body regions and procedure types, these results were examined further by determining whether there were any individual differences amongst participants. Independent samples t-tests were conducted to compare the following participant groups: males versus females; <25 year olds versus ≥25 year olds; participants who had been hospitalised versus those never hospitalised; participants previously examined by a medical student versus those never examined by a medical student; Asians versus Caucasians (sample sizes of participants identifying with other ethnic groups were too small to conduct any meaningful analyses); religious affiliation versus no religious affiliation; and for those who identified as being affiliated with a religion this group was subdivided into Christian versus non-Christian.

Individuals who were male, aged ≥25 years and Caucasian were more likely to permit formative year medical students to examine and conduct procedures on them (Table 1). Additionally, these individuals were more likely to have had prior experience with a medical student and hospitalised previously. Individuals affiliated to a religion, especially those of a non-Christian faith, were less likely to permit less advanced medical students examine and conduct procedures on them (Table 1).

Table 1  Mean values (with standard deviations in parentheses) of each group of participants for each body part and medical procedure for (a) the minimum year level a medical student must be undertaking and (b) the maximum number of observing medical students permitted to be present

	Gender		Age		Hospitalised		Prior student exam		Ethnicity		Religion		Christianity
Body part/procedure	Male	Female	≥25 years	<25 years	Yes	No	Yes	No	Asian	Caucasian	Religion	No religion	Christian	Non-Christian
Medical students' year of study
Head and neck	2.57 (1.68)	2.68 (1.66)	2.71 (1.72)	2.60 (1.61)	2.54 (1.60)	2.88 (1.78)	2.44 (1.53)	2.75 (1.72)	3.61 (1.85)	2.41 (1.51)	2.73 (1.66)	2.57 (1.66)	2.66 (1.57)	3.26 (2.14)
	(N = 121)	(N = 246)	(N = 139)	(N = 225)	(N = 261)	(N = 105)	(N = 124)	(N = 243)	(N = 56)	(N = 256)	(N = 184)	(N = 182)	(N = 155)	(N = 27)
	0.59	p = .557	0.65	p = .515	1.73	p = .084	1.71	p = .087	5.15	p ≤ .001	0.93	p = .351	1.74	p = .083
Hand	2.08 (1.51)	1.91 (1.31)	1.98 (1.44)	1.95 (1.32)	1.87 (1.30)	2.19 (1.54)	1.83 (1.28)	2.04 (1.42)	2.80 (1.77)	1.77 (1.21)	2.09 (1.40)	1.85 (1.35)	1.97 (1.28)	2.85 (1.85)
	(N = 119)	(N = 241)	(N = 136)	(N = 221)	(N = 255)	(N = 104)	(N = 121)	(N = 239)	(N = 54)	(N = 252)	(N = 181)	(N = 178)	(N = 153)	(N = 26)
	1.11	p = .268	0.16	p = .876	2.02	p = .004	1.32	p = .188	5.18	p ≤ .001	1.61	p = .108	3.00	p = .003
Arm and shoulder	2.32 (1.66)	2.26 (1.45)	2.25 (1.53)	2.30 (1.51)	2.14 (1.39)	2.62 (1.75)	2.14 (1.43)	2.35 (1.56)	3.13 (1.93)	2.06 (1.34)	2.39 (1.59)	2.18 (1.44)	2.28 (1.49)	3.12 (1.99)
	(N = 117)	(N = 239)	(N = 134)	(N = 219)	(N = 254)	(N = 101)	(N = 120)	(N = 236)	(N = 54)	(N = 248)	(N = 180)	(N = 175)	(N = 152)	(N = 26)
	0.31	p = .759	0.29	p = .776	2.74	p = .006	1.23	p = .218	4.86	p ≤ .001	1.31	p = .190	2.50	p = .013
Upper body	2.66 (1.72)	2.92 (1.60)	2.69 (1.65)	2.91 (1.62)	2.67 (1.58)	3.25 (1.74)	2.62 (1.66)	2.95 (1.63)	3.93 (1.90)	2.57 (1.49)	3.07 (1.75)	2.61 (1.50)	2.93 (1.69)	4.04 (1.82)
	(N = 116)	(N = 239)	(N = 134)	(N = 218)	(N = 254)	(N = 100)	(N = 120)	(N = 235)	(N = 54)	(N = 247)	(N = 180)	(N = 174)	(N = 152)	(N = 26)
	1.40	p = .161	1.19	p = .233	3.03	p = .003	1.83	p = .068	5.72	p ≤ .001	2.67	p = .008	3.07	p = .003
Abdomen	2.87 (1.79)	3.29 (1.74)	3.07 (1.86)	3.18 (1.68)	3.00 (1.69)	3.54 (1.88)	2.90 (1.70)	3.28 (1.78)	4.13 (1.92)	2.90 (1.62)	3.34 (1.86)	2.97 (1.63)	3.17 (1.80)	4.46 (1.92)
	(N = 116)	(N = 239)	(N = 134)	(N = 218)	(N = 254)	(N = 100)	(N = 120)	(N = 235)	(N = 54)	(N = 247)	(N = 180)	(N = 174)	(N = 152)	(N = 26)
	2.11	p = .036	0.54	p = .588	2.63	p = .009	1.93	p = .054	4.87	p ≤ .001	2.03	p = .043	3.35	p = .001
Back	2.64 (1.72)	3.06 (1.77)	2.87 (1.84)	2.92 (1.69)	2.80 (1.70)	3.21 (1.88)	2.70 (1.74)	3.03 (1.77)	3.85 (1.97)	2.69 (1.66)	3.12 (1.86)	2.73 (1.64)	2.97 (1.81)	4.12 (1.88)
	(N = 116)	(N = 239)	(N = 134)	(N = 218)	(N = 254)	(N = 100)	(N = 120)	(N = 235)	(N = 54)	(N = 247)	(N = 180)	(N = 174)	(N = 152)	(N = 26)
	2.12	p = .035	0.29	p = .769	1.96	p = .050	1.69	p = .091	4.50	p ≤ .001	2.08	p = .039	2.96	p = .003
Groin	3.55 (1.90)	4.19 (1.91)	3.66 (2.10)	4.16 (1.78)	3.81 (1.91)	4.41 (1.94)	3.72 (2.02)	4.11 (1.88)	4.78 (1.92)	3.77 (1.87)	4.18 (1.99)	3.79 (1.84)	4.01 (1.96)	5.23 (1.73)
	(N = 116)	(N = 239)	(N = 134)	(N = 218)	(N = 254)	(N = 100)	(N = 120)	(N = 235)	(N = 54)	(N = 247)	(N = 180)	(N = 174)	(N = 152)	(N = 26)
	2.95	p = .003	2.35	p = .019	2.65	p = .008	1.85	p = .066	3.58	p ≤ .001	1.94	p = .053	2.99	p = .003
Genitals	4.91 (1.99)	5.66 (1.57)	5.16 (1.83)	5.57 (1.69)	5.35 (1.74)	5.59 (1.78)	5.19 (1.89)	5.53 (1.67)	5.85 (1.66)	5.31 (1.78)	5.53 (1.82)	5.32 (1.65)	5.46 (1.84)	6.08 (1.38)
	(N = 116)	(N = 239)	(N = 134)	(N = 218)	(N = 254)	(N = 100)	(N = 120)	(N = 235)	(N = 54)	(N = 247)	(N = 180)	(N = 174)	(N = 152)	(N = 26)
	3.84	p ≤ .001	2.18	p = .030	1.14	p = .255	1.74	p = .083	2.04	p = .042	1.15	p = .253	1.99	p = .106
Feet and legs	2.37 (1.63)	2.35 (1.49)	2.27 (1.54)	2.41 (1.52)	2.22 (1.43)	2.70 (1.72)	2.17 (1.46)	2.45 (1.56)	3.37 (1.88)	2.06 (1.34)	2.54 (1.61)	2.17 (1.44)	2.38 (1.49)	3.50 (1.94)
	(N = 115)	(N = 239)	(N = 134)	(N = 217)	(N = 254)	(N = 99)	(N = 120)	(N = 234)	(N = 54)	(N = 246)	(N = 179)	(N = 174)	(N = 151)	(N = 26)
	0.15	p = .879	0.82	p = .415	2.67	p = .008	1.67	p = .097	6.02	p ≤ .001	2.27	p = .024	3.36	p = .001
Hips	2.72 (1.78)	3.05 (1.71)	2.88 (1.76)	2.99 (1.71)	2.83 (1.71)	3.24 (1.79)	2.76 (1.70)	3.04 (1.76)	3.85 (1.95)	2.68 (1.58)	3.21 (1.85)	2.69 (1.58)	2.99 (1.75)	4.54 (1.92)
	(N = 114)	(N = 238)	(N = 132)	(N = 217)	(N = 252)	(N = 99)	(N = 119)	(N = 233)	(N = 54)	(N = 244)	(N = 178)	(N = 173)	(N = 150)	(N = 26)
	1.70	p = .091	0.56	p = .574	2.03	p = .043	1.40	p = .163	4.69	p ≤ .001	2.83	p = .005	4.10	p ≤ .001
Blood pressure	1.88 (1.52)	1.67 (1.11)	1.63 (1.25)	1.80 (1.27)	1.62 (1.06)	2.04 (1.63)	1.61 (1.14)	1.80 (1.32)	2.62 (1.76)	1.47 (0.98)	1.85 (1.36)	1.63 (1.15)	1.68 (1.19)	2.92 (1.82)
	(N = 113)	(N = 235)	(N = 132)	(N = 213)	(N = 249)	(N = 98)	(N = 119)	(N = 229)	(N = 53)	(N = 241)	(N = 175)	(N = 172)	(N = 148)	(N = 25)
	1.41	p = .158	1.21	p = .226	2.83	p = .005	1.34	p = .182	6.57	p ≤ .001	1.65	p = .099	4.41	p ≤ .001
Blood test	3.70 (1.71)	4.08 (1.82)	3.63 (1.90)	4.14 (1.68)	3.80 (1.78)	4.34 (1.78)	3.58 (1.77)	4.15 (1.77)	4.72 (1.77)	3.83 (1.81)	4.13 (1.88)	3.80 (1.68)	4.05 (1.91)	4.68 (1.60)
	(N = 113)	(N = 234)	(N = 131)	(N = 213)	(N = 248)	(N = 98)	(N = 118)	(N = 229)	(N = 53)	(N = 240)	(N = 174)	(N = 172)	(N = 147)	(N = 25)
	1.87	p = .062	2.56	p = .011	2.52	p = .012	2.81	p = .005	3.27	p = .001	1.75	p = .080	1.55	p = .124
Breast exam			4.87 (1.81)	5.19 (1.55)	5.02 (1.69)	5.23 (1.60)	4.74 (1.69)	5.24 (1.63)	5.50 (1.84)	4.97 (1.69)	5.30 (1.62)	4.86 (1.69)	5.17 (1.65)	5.94 (1.25)
			(N = 92)	(N = 139)	(N = 172)	(N = 62)	(N = 77)	(N = 157)	(N = 26)	(N = 168)	(N = 117)	(N = 116)	(N = 99)	(N = 17)
			1.46	p = .146	0.84	p = .399	2.16	p = .032	1.47	p = .143	2.02	p = .045	1.83	p = .069
Digital rectal exam	5.50 (1.71)	6.15 (1.24)	5.67 (1.63)	6.10 (1.36)	5.94 (1.42)	5.95 (1.51)	5.90 (1.42)	5.96 (1.46)	6.04 (1.58)	5.88 (1.48)	6.06 (1.46)	5.83 (1.41)	6.04 (1.45)	6.32 (1.21)
	(N = 113)	(N = 234)	(N = 131)	(N = 213)	(N = 248)	(N = 98)	(N = 118)	(N = 229)	(N = 53)	(N = 240)	(N = 174)	(N = 172)	(N = 147)	(N = 25)
	3.96	p ≤ .001	2.69	p = .008	0.05	p = .956	0.35	p = .723	0.72	p = .474	1.47	p = .144	0.91	p = .364
Ear exam	2.73 (1.71)	2.74 (1.68)	2.51 (1.62)	2.86 (1.71)	2.64 (1.59)	2.97 (1.90)	2.44 (1.58)	2.89 (1.73)	3.66 (1.90)	2.48 (1.56)	2.87 (1.79)	2.61 (1.58)	2.76 (1.70)	3.72 (2.05)
	(N = 112)	(N = 234)	(N = 131)	(N = 212)	(N = 247)	(N = 98)	(N = 117)	(N = 229)	(N = 53)	(N = 239)	(N = 174)	(N = 171)	(N = 147)	(N = 25)
	0.04	p = .971	1.88	p = .060	1.66	p = .098	2.31	p = .021	4.79	p ≤ .001	1.46	p = .145	2.54	p = .012
ECG	2.82 (1.90)	3.07 (1.75)	2.68 (1.84)	3.17 (1.75)	2.85 (1.72)	3.33 (1.96)	2.61 (1.67)	3.18 (1.84)	4.06 (2.01)	2.66 (1.62)	3.17 (1.95)	2.82 (1.63)	2.95 (1.83)	4.60 (2.04)
	(N = 111)	(N = 233)	(N = 131)	(N = 210)	(N = 245)	(N = 98)	(N = 116)	(N = 228)	(N = 53)	(N = 237)	(N = 174)	(N = 169)	(N = 147)	(N = 25)
	1.22	p = .224	2.48	p = .014	2.23	p = .026	2.81	p = .005	5.43	p ≤ .001	1.77	p = .077	4.11	p ≤ .001
Eye exam	3.25 (1.92)	3.20 (1.91)	2.94 (1.85)	3.37 (1.92)	3.12 (1.89)	3.44 (1.97)	2.82 (1.82)	3.42 (1.93)	4.21 (2.01)	2.90 (1.81)	3.29 (2.00)	3.15 (1.83)	3.18 (1.96)	4.17 (2.01)
	(N = 111)	(N = 231)	(N = 130)	(N = 209)	(N = 243)	(N = 98)	(N = 115)	(N = 227)	(N = 52)	(N = 236)	(N = 173)	(N = 168)	(N = 147)	(N = 24)
	0.24	p = .811	2.05	p = .041	1.40	p = .164	2.77	p = .006	4.64	p ≤ .001	0.65	p = .518	2.28	p = .024
Injection in arm	4.23 (1.85)	4.32 (1.82)	3.98 (1.97)	4.47 (1.67)	4.15 (1.83)	4.63 (1.79)	3.93 (1.90)	4.48 (1.76)	5.17 (1.59)	4.10 (1.84)	4.39 (1.94)	4.22 (1.69)	4.29 (1.97)	5.17 (1.61)
	(N = 111)	(N = 231)	(N = 130)	(N = 209)	(N = 243)	(N = 98)	(N = 115)	(N = 227)	(N = 52)	(N = 236)	(N = 173)	(N = 168)	(N = 147)	(N = 24)
	0.43	p = .669	2.43	p = .016	2.21	p = .028	2.65	p = .008	3.91	p ≤ .001	0.85	p = .398	2.08	p = .039
Insert urinary catheter	5.73 (1.50)	6.08 (1.25)	5.72 (1.55)	6.12 (1.17)	5.97 (1.33)	5.96 (138)	5.81 (1.50)	6.05 (1.25)	6.08 (1.43)	5.96 (1.33)	6.12 (1.27)	5.84 (1.38)	6.07 (1.27)	6.54 (0.88)
	(N = 111)	(N = 231)	(N = 130)	(N = 209)	(N = 243)	(N = 98)	(N = 115)	(N = 227)	(N = 52)	(N = 236)	(N = 173)	(N = 168)	(N = 147)	(N = 24)
	2.28	p = .023	2.75	p = .006	0.07	p = .941	1.56	p = .119	0.56	p = .577	1.93	p = .055	1.75	p = .082
Insert IV drip	4.64 (1.73)	4.93 (1.67)	4.60 (1.85)	4.96 (1.57)	4.77 (1.66)	4.97 (1.77)	4.46 (1.78)	5.02 (1.62)	5.43 (1.50)	4.69 (1.71)	4.92 (1.75)	4.77 (1.61)	4.81 (1.76)	5.75 (1.42)
	(N = 110)	(N = 230)	(N = 129)	(N = 208)	(N = 241)	(N = 98)	(N = 114)	(N = 226)	(N = 51)	(N = 236)	(N = 172)	(N = 167)	(N = 146)	(N = 24)
	1.48	p = .140	1.89	p = .059	0.97	p = .331	2.87	p = .004	2.88	p = .004	0.83	p = .406	2.49	p = .014
Listen to chest	2.03 (1.66)	1.94 (1.39)	1.95 (1.57)	1.98 (1.44)	1.80 (1.30)	2.38 (1.81)	1.80 (1.35)	2.05 (1.54)	3.16 (1.93)	1.65 (1.18)	2.07 (1.58)	1.87 (1.37)	1.95 (1.50)	2.92 (1.84)
	(N = 110)	(N = 230)	(N = 129)	(N = 208)	(N = 241)	(N = 98)	(N = 114)	(N = 226)	(N = 51)	(N = 236)	(N = 172)	(N = 167)	(N = 146)	(N = 24)
	0.51	p = .609	0.13	p = .893	3.29	p = .001	1.50	p = .135	7.27	p ≤ .001	1.25	p = .212	2.84	p = .005
Oral temperature	1.97 (1.64)	1.73 (1.23)	1.67 (1.29)	1.90 (1.43)	1.67 (1.18)	2.14 (1.75)	1.58 (1.13)	1.92 (1.48)	2.69 (1.82)	1.54 (1.08)	1.91 (1.53)	1.71 (1.21)	1.74 (1.34)	3.00 (2.13)
	(N = 110)	(N = 230)	(N = 129)	(N = 208)	(N = 241)	(N = 98)	(N = 114)	(N = 226)	(N = 51)	(N = 236)	(N = 172)	(N = 167)	(N = 146)	(N = 24)
	1.52	p = .130	1.50	p = .134	2.87	p = .004	2.19	p = .029	5.96	p ≤ .001	1.30	p = .196	3.89	p ≤ .001
Pap smear			5.68 (1.54)	6.01 (1.21)	5.86 (1.37)	5.92 (1.38)	5.60 (1.45)	6.01 (1.31)	6.08 (1.66)	5.86 (1.36)	6.01 (1.29)	5.77 (1.41)	5.90 (1.35)	6.63 (0.62)
			(N = 90)	(N = 137)	(N = 168)	(N = 62)	(N = 75)	(N = 155)	(N = 25)	(N = 166)	(N = 115)	(N = 114)	(N = 98)	(N = 16)
			1.84	p = .068	0.28	p = .783	2.16	p = .032	0.75	p = .457	1.32	p = .188	2.11	p = .037
Testicular exam			4.90 (1.94)	5.17 (1.99)	4.96 (2.05)	5.33 (1.82)	5.15 (2.18)	5.03 (1.86)	5.81 (1.60)	4.87 (2.07)	5.00 (2.16)	5.15 (1.76)	5.02 (2.20)	5.38 (1.60)
			(N = 39)	(N = 71)	(N = 73)	(N = 36)	(N = 39)	(N = 71)	(N = 26)	(N = 70)	(N = 57)	(N = 53)	(N = 48)	(N = 8)
			0.69	p = .492	0.93	p = .355	0.32	p = .751	2.08	p = .040	0.40	p = .690	0.44	p = .665
Number of observing medical students
Head and neck	2.41 (1.52)	2.41 (1.38)	2.47 (1.41)	2.37 (1.44)	2.37 (1.42)	2.51 (1.43)	2.33 (1.39)	2.46 (1.44)	3.31 (1.46)	2.26 (1.37)	2.58 (1.46)	2.23 (1.36)	2.48 (1.47)	3.15 (1.46)
	(N = 115)	(N = 237)	(N = 131)	(N = 218)	(N = 250)	(N = 100)	(N = 122)	(N = 230)	(N = 52)	(N = 246)	(N = 179)	(N = 172)	(N = 151)	(N = 26)
	0.03	p = .976	0.67	p = .501	0.82	p = .413	0.81	p = .420	4.13	p ≤ .001	2.30	p = .022	2.18	p = .031
Hand	2.16 (1.53)	1.97 (1.27)	2.02 (1.30)	2.04 (1.40)	1.96 (1.33)	2.20 (1.44)	1.92 (1.29)	2.09 (1.39)	2.56 (1.61)	1.88 (1.27)	2.20 (1.40)	1.87 (1.31)	2.07 (1.34)	3.00 (1.56)
	(N = 115)	(N = 238)	(N = 132)	(N = 218)	(N = 252)	(N = 99)	(N = 120)	(N = 233)	(N = 52)	(N = 247)	(N = 178)	(N = 174)	(N = 151)	(N = 25)
	1.20	p = .230	0.17	p = .862	1.50	p = .134	1.13	p = .257	3.34	p = .001	2.28	p = .023	3.16	p = .002
Arm and shoulder	2.38 (1.54)	2.24 (1.37)	2.28 (1.39)	2.29 (1.45)	2.20 (1.39)	2.50 (1.51)	2.13 (1.32)	2.37 (1.47)	2.84 (1.54)	2.14 (1.37)	2.47 (1.50)	2.11 (1.33)	2.36 (1.48)	3.08 (1.50)
	(N = 112)	(N = 236)	(N = 131)	(N = 214)	(N = 250)	(N = 96)	(N = 120)	(N = 228)	(N = 51)	(N = 243)	(N = 176)	(N = 171)	(N = 149)	(N = 25)
	0.87	p = .385	0.08	p = .940	1.74	p = .084	1.47	p = .144	3.24	p = .001	2.33	p = .020	2.25	p = .026
Upper body	2.52 (1.52)	2.87 (1.37)	2.78 (1.36)	2.74 (1.46)	2.69 (1.41)	2.95 (1.45)	2.64 (1.41)	2.83 (1.43)	3.38 (1.38)	2.63 (1.41)	2.94 (1.41)	2.58 (1.43)	2.82 (1.41)	3.74 (1.14)
	(N = 111)	(N = 231)	(N = 130)	(N = 210)	(N = 246)	(N = 94)	(N = 118)	(N = 224)	(N = 48)	(N = 241)	(N = 170)	(N = 171)	(N = 145)	(N = 23)
	2.15	p = .033	0.24	p = 0.808	1.48	p = .139	1.17	p = .242	3.36	p = .001	2.36	p = .019	2.97	p = .003
Abdomen	2.66 (1.56)	2.93 (1.42)	2.84 (1.39)	2.85 (1.52)	2.78 (1.47)	3.03 (1.47)	2.66 (1.45)	2.95 (1.48)	3.51 (1.43)	2.72 (1.42)	2.95 (1.43)	2.74 (1.51)	2.83 (1.42)	3.81 (1.25)
	(N = 111)	(N = 228)	(N = 127)	(N = 210)	(N = 245)	(N = 92)	(N = 119)	(N = 220)	(N = 49)	(N = 239)	(N = 167)	(N = 171)	(N = 144)	(N = 21)
	1.63	p = .105	0.03	p = .975	1.43	p = .153	1.74	p = .083	3.55	p ≤ .001	1.27	p = .205	3.01	p = .003
Back	2.51 (1.54)	2.70 (1.38)	2.65 (1.35)	2.64 (1.48)	2.52 (1.40)	2.96 (1.48)	2.41 (1.36)	2.76 (1.46)	3.48 (1.45)	2.44 (1.35)	2.86 (1.46)	2.41 (1.38)	2.73 (1.43)	3.74 (1.36)
	(N = 113)	(N = 226)	(N = 126)	(N = 211)	(N = 242)	(N = 95)	(N = 116)	(N = 223)	(N = 50)	(N = 237)	(N = 170)	(N = 168)	(N = 145)	(N = 23)
	1.15	p = .250	0.10	p = .923	2.57	p = .011	2.19	p = .029	4.90	p ≤ .001	2.94	p = .003	3.17	p = .002
Groin	3.35 (1.54)	3.54 (1.39)	3.22 (1.46)	3.63 (1.41)	3.39 (1.46)	3.67 (1.39)	3.25 (1.49)	3.59 (1.41)	3.79 (1.37)	3.41 (1.44)	3.55 (1.46)	3.39 (1.44)	3.46 (1.47)	4.24 (1.09)
	(N = 107)	(N = 203)	(N = 114)	(N = 195)	(N = 223)	(N = 85)	(N = 107)	(N = 203)	(N = 42)	(N = 221)	(N = 151)	(N = 158)	(N = 129)	(N = 21)
	1.11	p = .269	2.44	p = .015	1.55	p = .123	1.91	p = .053	1.57	p = .117	0.96	p = .340	2.33	p = .021
Genitals	4.04 (1.25)	4.50 (0.82)	4.33 (0.94)	4.33 (1.08)	4.38 (0.89)	4.16 (1.35)	4.19 (1.14)	4.41 (0.94)	3.84 (1.43)	4.40 (0.92)	4.27 (1.15)	4.39 (0.91)	4.27 (1.15)	4.55 (0.69)
	(N = 81)	(N = 139)	(N = 92)	(N = 127)	(N = 162)	(N = 56)	(N = 80)	(N = 140)	(N = 25)	(N = 161)	(N = 98)	(N = 121)	(N = 86)	(N = 11)
	3.34	p = .001	0.03	p = .974	1.40	p = .163	1.59	p = .114	2.62	p = .009	0.88	p = .378	0.78	p = .437
Feet and legs	2.38 (1.55)	2.37 (1.31)	2.35 (1.31)	2.39 (1.43)	2.30 (1.35)	2.57 (1.47)	2.23 (1.31)	2.45 (1.42)	3.02 (1.45)	2.18 (1.30)	2.53 (1.39)	2.21 (1.37)	2.39 (1.34)	3.44 (1.39)
	(N = 112)	(N = 235)	(N = 130)	(N = 214)	(N = 249)	(N = 96)	(N = 120)	(N = 227)	(N = 52)	(N = 241)	(N = 176)	(N = 170)	(N = 149)	(N = 25)
	0.00	p = .997	0.22	p = .826	1.66	p = .098	1.46	p = .144	4.14	p ≤ .001	2.21	p = .028	3.60	p ≤ .001
Hips	2.72 (1.60)	2.90 (1.38)	2.91 (1.39)	2.82 (1.49)	2.76 (1.44)	3.03 (1.48)	2.62 (1.39)	2.95 (1.47)	3.47 (1.46)	2.74 (1.40)	2.96 (1.47)	2.72 (1.43)	2.83 (1.47)	3.86 (1.17)
	(N = 111)	(N = 228)	(N = 128)	(N = 209)	(N = 242)	(N = 95)	(N = 117)	(N = 222)	(N = 51)	(N = 237)	(N = 168)	(N = 170)	(N = 144)	(N = 22)
	1.06	p = .289	0.54	p = .589	1.57	p = .118	2.00	p = .046	3.34	p = .001	1.56	p = .119	3.14	p = .002
Blood pressure	2.19 (1.47)	1.88 (1.26)	2.05 (1.27)	1.95 (1.38)	1.90 (1.29)	2.20 (1.43)	1.94 (1.28)	2.00 (1.36)	2.47 (1.54)	1.84 (1.22)	2.12 (1.41)	1.83 (1.23)	2.05 (1.37)	2.67 (1.63)
	(N = 110)	(N = 232)	(N = 128)	(N = 211)	(N = 245)	(N = 95)	(N = 118)	(N = 224)	(N = 51)	(N = 237)	(N = 171)	(N = 170)	(N = 145)	(N = 24)
	2.00	p = .046	0.66	p = .509	1.88	p = .061	0.42	p = .675	3.22	p = .001	2.05	p = .042	2.00	p = .048
Blood test	2.67 (1.55)	2.45 (1.45)	2.53 (1.41)	2.51 (1.53)	2.46 (1.45)	2.68 (1.56)	2.51 (1.46)	2.53 (1.50)	2.84 (1.62)	2.47 (1.46)	2.56 (1.53)	2.47 (1.44)	2.49 (1.51)	3.05 (1.66)
	(N = 105)	(N = 204)	(N = 118)	(N = 190)	(N = 222)	(N = 85)	(N = 111)	(N = 198)	(N = 45)	(N = 213)	(N = 152)	(N = 156)	(N = 129)	(N = 21)
	1.24	p = .217	0.16	p = .870	1.18	p = .240	0.07	p = .947	1.54	p = .125	0.50	p = .617	1.56	p = .122
Breast exam			4.14 (0.99)	4.13 (1.24)	4.17 (1.08)	4.04 (1.28)	4.00 (1.21)	4.21 (1.10)	3.80 (1.61)	4.22 (1.06)	4.28 (1.10)	4.00 (1.16)	4.24 (1.14)	4.60 (0.70)
			(N = 69)	(N = 106)	(N = 129)	(N = 47)	(N = 63)	(N = 113)	(N = 15)	(N = 130)	(N = 82)	(N = 93)	(N = 72)	(N = 10)
			0.07	p = .942	0.66	p = .511	1.19	p = .236	1.36	p = .177	1.63	p = .104	0.98	p = .331
Digital rectal exam	4.08 (1.22)	4.58 (0.81)	4.48 (0.82)	4.29 (1.15)	4.47 (0.83)	4.13 (1.38)	4.43 (0.95)	4.35 (1.06)	3.80 (1.54)	4.50 (0.84)	4.29 (1.11)	4.44 (0.95)	4.37 (1.01)	4.13 (1.36)
	(N = 66)	(N = 100)	(N = 73)	(N = 92)	(N = 117)	(N = 47)	(N = 60)	(N = 106)	(N = 20)	(N = 119)	(N = 72)	(N = 93)	(N = 63)	(N = 8)
	3.21	p = .002	1.16	p = .246	1.96	p = .052	0.51	p = .610	3.00	p = .003	0.93	p = .353	0.61	p = .543
Ear exam	2.44 (1.56)	2.36 (1.41)	2.40 (1.41)	2.39 (1.49)	2.29 (1.41)	2.64 (1.55)	2.26 (1.40)	2.45 (1.49)	3.10 (1.62)	2.18 (1.36)	2.50 (1.50)	2.26 (1.41)	2.38 (1.43)	3.33 (1.69)
	(N = 109)	(N = 229)	(N = 128)	(N = 207)	(N = 242)	(N = 94)	(N = 117)	(N = 221)	(N = 51)	(N = 233)	(N = 169)	(N = 168)	(N = 143)	(N = 24)
	0.49	p = .628	0.07	p = .942	2.00	p = .046	1.10	p = .273	4.20	p ≤ .001	1.56	p = .120	2.93	p = .004
ECG	2.32 (1.50)	2.60 (1.45)	2.53 (1.40)	2.52 (1.52)	2.48 (1.45)	2.59 (1.53)	2.45 (1.45)	2.54 (1.48)	2.91 (1.63)	2.44 (1.44)	2.63 (1.52)	2.39 (1.42)	2.52 (1.49)	3.29 (1.55)
	(N = 105)	(N = 225)	(N = 126)	(N = 201)	(N = 237)	(N = 91)	(N = 115)	(N = 215)	(N = 47)	(N = 232)	(N = 163)	(N = 166)	(N = 140)	(N = 21)
	1.57	p = .118	0.09	p = .932	0.64	p = .521	0.51	p = .608	2.02	p = .045	1.48	p = .139	2.19	p = .030
Eye exam	2.43 (1.53)	2.35 (1.36)	2.48 (1.39)	2.32 (1.43)	2.29 (1.37)	2.59 (1.50)	2.28 (1.35)	2.43 (1.45)	2.89 (1.59)	2.29 (1.36)	2.46 (1.43)	2.29 (1.41)	2.37 (1.37)	3.18 (1.59)
	(N = 104)	(N = 218)	(N = 126)	(N = 194)	(N = 227)	(N = 93)	(N = 113)	(N = 209)	(N = 47)	(N = 225)	(N = 163)	(N = 158)	(N = 139)	(N = 22)
	0.47	p = .638	0.98	p = .326	1.73	p = .085	0.89	p = .373	2.66	p = .008	1.07	p = .286	2.53	p = .012
Injection in arm	2.48 (1.48)	2.60 (1.46)	2.60 (1.42)	2.54 (1.49)	2.51 (1.42)	2.68 (1.56)	2.65 (1.47)	2.52 (1.46)	3.05 (1.48)	2.51 (1.47)	2.57 (1.46)	2.55 (1.47)	2.48 (1.45)	3.22 (1.48)
	(N = 94)	(N = 198)	(N = 110)	(N = 181)	(N = 208)	(N = 82)	(N = 102)	(N = 190)	(N = 41)	(N = 204)	(N = 143)	(N = 148)	(N = 123)	(N = 18)
	0.67	p = .505	0.36	p = .718	0.88	p = .378	0.73	p = .465	2.12	p = .035	0.11	p = .911	2.03	p = .044
Insert urinary catheter	3.89 (1.38)	4.30 (0.99)	4.26 (1.05)	4.06 (1.23)	4.16 (1.07)	4.08 (1.38)	4.05 (1.28)	4.20 (1.10)	3.90 (1.51)	4.22 (1.07)	4.04 (1.24)	4.24 (1.09)	4.01 (1.24)	4.63 (0.52)
	(N = 62)	(N = 106)	(N = 69)	(N = 98)	(N = 117)	(N = 49)	(N = 58)	(N = 110)	(N = 21)	(N = 121)	(N = 78)	(N = 89)	(N = 69)	(N = 8)
	2.26	p = .025	1.09	p = .276	0.41	p = .685	0.79	p = .433	1.18	p = 0.241	1.10	p = .275	1.37	p = .175
Insert IV drip	2.52 (1.52)	2.79 (1.48)	2.76 (1.46)	2.66 (1.52)	2.68 (1.47)	2.73 (1.58)	2.77 (1.48)	2.66 (1.51)	2.95 (1.55)	2.70 (1.48)	2.77 (1.50)	2.61 (1.49)	2.66 (1.47)	3.86 (1.41)
	(N = 93)	(N = 180)	(N = 103)	(N = 169)	(N = 196)	(N = 75)	(N = 98)	(N = 175)	(N = 37)	(N = 196)	(N = 135)	(N = 137)	(N = 119)	(N = 14)
	1.43	p = .154	0.54	p = .593	0.24	p = .808	0.57	p = .568	0.91	p = .365	0.91	p = .365	2.91	p = .004
Listen to chest	2.23 (1.52)	2.27 (1.38)	2.26 (1.39)	2.25 (1.44)	2.17 (1.39)	2.47 (1.48)	2.14 (1.33)	2.32 (1.47)	2.90 (1.57)	2.15 (1.35)	2.39 (1.47)	2.11 (1.36)	2.26 (1.40)	3.22 (1.65)
	(N = 108)	(N = 228)	(N = 127)	(N = 206)	(N = 239)	(N = 95)	(N = 114)	(N = 222)	(N = 49)	(N = 234)	(N = 169)	(N = 166)	(N = 144)	(N = 23)
	0.22	p = .829	0.08	p = .939	1.78	p = .076	1.07	p = .286	3.42	p = .001	1.82	p = .069	2.97	p = .003
Oral temperature	2.24 (1.54)	2.11 (1.33)	2.11 (1.33)	2.17 (1.43)	2.06 (1.36)	2.39 (1.49)	2.00 (1.28)	2.23 (1.45)	2.61 (1.61)	2.06 (1.33)	2.22 (1.46)	2.07 (1.34)	2.10 (1.37)	3.13 (1.74)
	(N = 107)	(N = 229)	(N = 127)	(N = 206)	(N = 239)	(N = 95)	(N = 114)	(N = 222)	(N = 49)	(N = 234)	(N = 169)	(N = 169)	(N = 144)	(N = 23)
	0.82	p = .415	0.41	p = .683	1.95	p = .052	1.43	p = .155	2.52	p = .012	1.04	p = .300	3.24	p = .001
Pap smear			4.56 (0.80)	4.20 (1.31)	4.39 (1.09)	4.24 (1.28)	4.29 (1.20)	4.38 (1.10)	3.33 (1.87)	4.48 (1.00)	4.35 (1.25)	4.34 (1.05)	4.33 (1.28)	4.60 (0.89)
			(N = 52)	(N = 76)	(N = 96)	(N = 33)	(N = 48)	(N = 81)	(N = 9)	(N = 96)	(N = 60)	(N = 68)	(N = 55)	(N = 5)
			1.77	p = .079	0.62	p = .535	0.44	p = .662	3.02	p = .003	0.06	p = .954	0.47	p = .643
Testicular exam			4.00 (1.09)	3.89 (1.46)	3.96 (1.25)	3.79 (1.53)	3.45 (1.65)	4.14 (1.13)	4.00 (1.52)	3.89 (1.31)	3.88 (1.43)	3.97 (1.26)	3.78 (1.42)	4.83 (0.41)
			(N = 26)	(N = 46)	(N = 46)	(N = 24)	(N = 22)	(N = 50)	(N = 14)	(N = 47)	(N = 34)	(N = 38)	(N = 27)	(N = 6)
			0.33	p = .743	0.49	p = .629	2.05	p = .044	0.26	p = .798	0.29	p = .774	1.78	p = .085

Notes: (a) Lower mean values for the minimum year level a medical student must be undertaking pertain to a lower year level (e.g. 1 = first year; 7 = would not permit) and (b) lower mean values for the maximum number of observing medical students permitted to be present pertain to permitting more observing medical students to be present (e.g. 1 = permits 14 students; 2 = permits 11 students).

When participants were asked regarding the number of observing medical students they would permit to be present for examinations and procedures a similar pattern of results to that above was found (Table 1).

Generally, high mean ratings (indicating medical students of a higher level of study/less observing medical students) were obtained for examinations of intimate body regions (e.g. genitals) and procedures conducted in intimate body regions (e.g. pap smear). Additionally, for those procedures perceived to require more skill (e.g. injection in arm), participants required medical students of a more advanced level but were unconcerned regarding the number of observing medical students present.

Discussion

The results from this study suggest that a medical student's gender and ethnicity are generally unimportant factors for individuals to consider when consenting to most examinations/procedures conducted by a supervised medical student. However, caution must be taken when interpreting these findings because the present survey-based study only captured individuals’ attitudes which may not necessarily translate into their behaviours in reality. For example, individuals may give a socially desirable response when responding to questions pertaining to ethnicity in order to appear politically correct. With regards to gender, the only two exceptions to individuals being unconcerned with a medical students’ gender are that slightly more than half of all women would only permit a female medical student perform a breast examination and a pap smear.

The minimum year level of study a medical student must be undertaking for an individual to consent to an examination/procedure depended on the body region concerned and the procedure type. In general, less advanced medical students were permitted to examine body regions that are easily accessible (e.g. hands) with the frequency of participants permitting the examination decreasing the closer body parts came to the trunk (e.g. abdomen). For examinations involving intimate body regions (e.g. genitals) participants desired more advanced medical students or would not permit the examination. These findings are consistent with previous studies showing that medical students are generally comfortable with peer physical examinations of non-intimate body regions (e.g. O’Neill et al. 1998; Rees et al. 2004). Participants often commented that they would refuse to have a medical student examine their groin or genitals because of embarrassment, discomfort and being a private area. These findings suggest that medical courses should be structured in a manner such that more intimate examinations involving real patients are reserved for more advanced medical students.

The study showed that the general public are willing to allow formative year medical students to examine non-intimate body parts, according to Western customs and conduct non-intimate procedures (e.g. blood pressure measure). The survey population resided in a Western culture, thus the results may not be generalised to non-Western countries.

In the free comments sections of the survey participants indicated that they would refuse to have certain examinations/procedures because they perceived them to be uncomfortable (e.g. digital rectal examination, pap smear). Thus medical educators find it more difficult to obtain patients to be examined by medical students for more intimate examinations. Therefore such examinations are best reserved for more advanced medical students.

In addition, the results show that individuals are less likely to permit formative year medical students to conduct procedures with high levels of perceived skill (e.g. insertion of a urinary catheter). Ideally, individuals preferred senior medical students or qualified professionals perform such procedures. These results suggest that individuals made the assumption that a higher year level of study equates to these students being more capable of performing tasks associated with a high level of perceived skill. Perhaps individuals thought that students may have had some practise at the task at that stage in their studies (i.e. so that they themselves are not the student's first patient) or that skills for tasks with lower levels of perceived skill are transferable to procedures thought to require higher levels of perceived skills. Future studies could explore the reasoning as to why individuals are less inclined to permit formative year medical students to conduct procedures with high levels of perceived skill.

Analogous to previous studies showing that female students were generally more reluctant to have various body parts examined by a peer than male students, especially in the case of opposite-sex pairings (Chang & Power 2000; O’Neill et al. 1998; Power & Center 2005; Rees et al. 2004, 2005, 2007), we also found that female participants were less likely to allow themselves to be examined. This decreases opportunities for male medical students to gain experience examining female patients. Given that it is important for male medical students to gain experience in examining female patients, it may be beneficial to gradually introduce female patients to male students. This could possibly be achieved via medical educators initially inviting female patients, who are not familiar with medical student examinations, for examinations involving non-sensitive body areas. Once the medical students have gained the trust of female patients, then these patients could be approached to be examined for more sensitive body areas.

Our study shows that individuals not affiliated with a religion and those that are Caucasian are more likely to consent to being examined by a medical student than those who are affiliated with a religion and those that are non-Caucasian. These findings concord with previous studies showing that physical examinations by peers were less acceptable by students affiliated with a religion (Rees et al. 2005, 2007; but see also Rees et al. 2004), as well as among those that were non-Caucasian (Rees et al. 2007). Medical educators should be cognisant of these factors when targeting patients for recruitment purposes.

Individuals who have had experience with medical students in a health care setting are more likely to volunteer to be examined by medical students for on campus teaching purposes than those who have had no prior exposure to medical students. These findings are consistent with York et al.'s (2005) findings showing that patients who received medical student care within a hospital are more likely to volunteer to be seen by a medical student in the future. Therefore, in addition to targeting individuals that are Caucasian and not affiliated with a religion for on-campus teaching purposes, medical educators should also target individuals who have had experience with medical student care within a healthcare setting.

Participants who permitted a medical student to perform an examination/procedure generally permitted a larger number of medical students to observe as long as the examination/procedure was not in an intimate area (e.g. genitals). A few participants commented on being uncomfortable having a large number of students present. For example:

I would be happy to be examined by a medical student if only one or two were present. I understand that up to 15 students may be present at any one time. I would find this most unpleasant and an invasion of privacy. (58-year-old female)

Thus, medical educators need to be sensitive to the patient's wishes in terms of the number of students being present.

Participant characteristics were also associated with the number of observing students they would permit to be present. For example, Caucasian participants permitted more observing medical students to be present than Asian participants. Thus, medical educators and students need to be aware of the cultural sensitivity encompassing the number of observing students being present during examinations. It is particularly important that the students are aware of this during their formative training in a controlled teaching environment in order to be sensitive to the patient's needs in the clinical setting. Despite finding that participant characteristics are associated with the number of observing students permitted to be present, the results of the present study are limited in that they leave open the question as to why this difference exists. Would similar results be obtained if the survey were to be conducted in an Asian country?

Several participants not only commented on the importance of students examining real patients but also indicated that they themselves are reluctant to volunteer. For example:

I suppose it's important for them to learn, and I'm glad that any doctors I see would have had to learn on real patients. But at the same time, I don't necessarily want to BE that real patient! (20-year-old female)

Its [sic] essential, I just feel its [sic] not really necessary that I should be examined personally. (20-year-old male)

It is also interesting to note that many participants explicitly expressed that they would prefer someone more experienced than a medical student perform certain procedures (especially for more invasive procedures) but they themselves would deny the medical student the opportunity to gain the experience. For example:

would not want an injection from someone without experience (18-year-old male)

would prefer a professional with experience to do this [digital rectal examination] procedure (19-year-old female)

Patients are faced with a paradox in that they would like to have the most experienced medical professional treat them. However, on the other hand, they do not wish to be that first patient to provide a medical student with the opportunity to acquire medical skills.

Some participants’ comments indicate that some members of the general public have erroneous perceptions regarding medical procedures even though unfamiliar concepts and procedures were explained in the survey. For example:

I would worry about them stuffing up [the electrocardiogram] and electrocuting me! (30-year-old female)

Risk of AIDS (18-year-old male)

I would not want to trust the care of my eyes to a student. Would worry about getting poked/scratched. (30-year-old female)

… I don't like having to take off my shirt so that the doctor can listen to my chest. (29-year-old female)

These findings suggest that a medical school's number of volunteer patients could be increased if (a) patient recruitment adverts use lay terms to clearly explain what is involved in medical student examinations to reduce potential misconceptions and (b) to target individuals who are familiar with medical student examinations from prior experience (e.g. patients in teaching hospitals).

Participants also commented that they were concerned regarding medical students professionalism. For example:

I wouldn't feel comfortable with a student examining that area [groin region] as they are not yet professionals, and may not approach it in a professional manner. (22-year-old female)

For such an intimate examination [digital rectal examination], I would prefer someone fully trained and someone bound by a professional code of ethics/conduct. (23-year-old male)

This finding highlights the importance of medical educators adequately informing potential patient volunteers that medical students are taught medical professionalism concepts from the commencement of the course.

In conclusion, these results suggest that a medical student's year of study and the number of observing students present, but not their gender and ethnicity, are important factors individuals consider when consenting to an examination/procedure. Furthermore, individuals are more likely to prefer an advanced student for intimate body regions and procedures perceived to require a high level of skill. Individuals also permit fewer observing medical students to be present for examinations/procedures involving intimate body regions. The minimum year of study a medical student must be undertaking in order to consent to the examination/procedure and the number of observing students permitted appears to be affected by individuals’ characteristics (e.g. ethnicity). Taken together, these results provide useful information regarding the potential suitability of members of the general public to be targeted for medical student examinations. Furthermore, these results highlight factors medical educators need to be aware of in terms of selecting suitable patients to be examined by medical students for different examination/procedures types.

Practice points

• Individuals are generally unconcerned regarding a medical student's gender and ethnicity in relation to examinations by medical students.

• More advanced medical students are desired for examinations involving intimate body regions and procedures that are invasive.

• The more intimate the examinations the less observing medical students would be permitted to be present.

• Individuals who were male, aged ≥25 years, Caucasian and of no religious affiliation were more likely to permit formative year medical students to examine and conduct procedures on them.

• Individuals who had prior experience with a medical student and had been hospitalised previously were more likely to permit medical students to examine them.

Acknowledgements

This study was funded by the Research Development Award 2009, The University of Western Australia.

Declaration of interest: The authors report no declarations of interest.