‘They’ve all got to learn’. Medical students’ learning from patients in ambulatory (outpatient and general practice) consultations

Figures & data

Table

Practice points

Ambulatory learning is most effective when teachers: Create a warm climate for students and patients. Tell students what they expect of them and orientate them to individual consultations. Promote direct communication between student and patient, for example by the student interviewing the patient before the doctor. Give students an authentic role in the process of caring for the patient. Debrief students at the end.

Table 1.  Consultations analysed

	Student(s)		Patient		Doctor
Consultation No.	Gender(s)	Ethnicity	Gender	Age^a	Gender	Grade
1	Female	Caucasian	Female	Young adult	Female	Consultant
2	Female	Minority	Male	Older aged	Male	Consultant
3	Female	Minority	Male	Middle aged	Male	Consultant
4	Female	Caucasian	Female	Middle aged	Female	General practitioner
5	Female	Caucasian	Female	Older aged	Female	General practitioner
6	Female	Minority	Female	Older aged	Female	General practitioner
7	Female	Minority	Female	Middle aged	Male	Consultant
8	Female	Caucasian	Female	Middle aged	Male	Consultant
9	Female	Caucasian	Male	Middle aged	Male/Female	Consultant/Specialist registrar
10	Female	Caucasian	Female	Middle aged	Male	Consultant
11	Female	Caucasian	Female	Young adult	Female	Consultant
12	Female	Caucasian	Male	Middle aged	Male	Specialist registrar
13	Female	Caucasian	Female	Middle aged	Female	Consultant
14	Male	Minority	Female	Middle aged	Male	Consultant
15	Male	Minority	Male	Middle aged	Male	Consultant
16	Male/Female	Caucasian/Minority	Female	Middle aged	Male	Specialist registrar
17	Male	Minority	Male	Middle aged	Male	Consultant
18	Male	Minority	Male	Older aged	Female	General practitioner
19	Female	Caucasian	Female	Middle aged	Female	General practitioner
20	Female/Female	Caucasian/Caucasian	Male	Older aged	Male	Consultant
21	Female/Female	Caucasian/Caucasian	Male	Middle aged	Male	Consultant
22	Male	Caucasian	Male	Middle aged	Male	Specialist registrar
23	Female	Minority	Male	Middle aged	Male	Specialist registrar
24	Female	Caucasian	Female	Young adult	Female	Consultant
25	Female	Caucasian	Female	Young adult	Male	Consultant

Notes: ^aYoung adult–up to 30, Middle aged up to 70, Older person–70 upwards.

Box 1. Recommendations for supervising a medical student in an outpatient clinic or surgery

• Regard students as people who are scared of you and patients as people who feel warm towards students.

• Be approachable and friendly, not dictatorial.

• Consider that students may be more comfortable attending in pairs.

• Tell them what to expect from you and what you expect of them.

• Obtain every patient's consent for a student to be present and ensure the student knows you have done so.

• Orientate students to patients before consultations begin.

• If time and space permit, have them interview patients on their own first.

• Brief them or give them a written template to guide their interview/ examination.

• Arrange the furniture to make everybody feel included and promote good eye contact.

• Use your interactions with students to create a comfortable and relaxed climate for patients.

• Encourage direct verbal interaction with patients that makes students active participants in the consultation.

• Handle sensitive consultations carefully so you involve students to patients’ benefit rather than harm.

• Have students perform any hands-on procedures they are capable of on your behalf.

• Use physical examination to help them connect with patients.

• Allow them to practice presenting cases.

• Find out, conversationally, their level of knowledge and meet their learning need.

• Help them understand your questions if they seem to have difficulty answering them.

• Debrief at the end, summarise, and reinforce take home messages.

Table 2.  Benefits to students and patients of teaching consultations

	Students	Patients
Direct emotional benefits	Identified positively with patients/students Felt personally validated Felt satisfied
	Increased their confidence
		Felt: • Cared for • Greater comfort • Less anxiety and boredom
Indirect emotional benefits		Experienced the rewards of: • Helping • Training future doctors • Giving something back
Practical benefits	Obtained materials for obligatory case reports	Had more thorough/longer consultations
Cognitive benefits	• Saw exemplars of, and personified, things learned about in theory • Were helped to remember • Learned about the personal impact of disease
		Became better informed