Students with an autonomous role in hospital care – patients perceptions

Figures & data

Table

Practice points

Easing transition from student to doctor warrants new educational concepts that foster supported active participation (SAP) of medical students. SAP in hospital care as realized in the clinical education wards (CEWs) at Witten Herdecke University shows no impairment in the perceived quality of health care; it reveals high patient-centeredness and excellent recommendation rates. Patients appreciated SAP of medical students as a support to a deeper understanding of their condition and treatment. Crucial elements for successful SAP are autonomous relationship of students with their patients, authentic team integration with openness to students suggestions, and adequate clinical supervision. Integrating students into ward teams may enhance knowledge generation and patient centeredness in a health-care community.

Table 1. Description of clinical education wards (CEWs) and patients.

Specialty	Overall total	Internal medicine	Neurology	Pediatrics
Period		March 2009–December 2012	August 2011–June 2015	August 2011–June 2015
Number of final-year medical students	74	45	14	15
Number of supervising consultants/residents at the CEW	10/3	3/3	3/0	4/0
Patients
Number of discharged patients	1306	509	261	536
Exclusion criteria for survey:
Deceased	6	5	1	0
< 18 y. of age; (for pediatrics >18 y. of age)	1	0	0	1
Stay in hospital <2two nights	109	19	21	69
Readmission	34	15	5	14
Other (move, etc.)	20	9	8	3
Total excluded	165	47	35	83
Number of addressed patients	1136	461	226	449
Number of suitable questionnaires	528	210	101	217
Response rate	46.2%	45.6%	44.7%	48.3%
Number of female patients^a (%)	276 (53.9%)	123 (59.7%)	51 (52.0%)	102 (49.0%)
Age (average) of patients		62.6 ± 18.4 y	60.8 ± 16.9 y	7.5 ± 5.2 y

^a Missing values = 16 (3.0%).

Figure 1. Problem frequency in patients perceptions on treatment success, overall quality of care, and recommendation of hospital to others – comparing clinical education wards (CEW) with control groups (CG1 and CG2) using Mann-Whitney-U-test.

Figure 2. Problem frequency from patients’ or their parents’ (pediatrics) points of view on physician/student patient interaction (PPI) – comparing clinical education wards (CEW) with control groups (CG1 and CG2) using Mann-Whitney-U-test.

Figure 3. Patients’ perceptions on active student participation in patient care.

Table 2. Spearman rank correlation (r_S).

	Impact of student participation on patient care	Collaboration between physicians and students	Physician-patient-interaction (PPI)
Physician/student-patient-interaction (PPI)	0.267***	0.393***	(1.000)
Overall quality of care	0.233***	0.544***	0.548***
Recommendation of hospital to others	0.193***	0.362***	0.500***

Level of significance (two-sided): ***p ≤ 0.001.

Table 3. Qualitative analysis of free-text responses.

Topics of critical response to students (n = 9) • Too little/too late physician contact. • Too late information on implications of the clinical education ward and the role of final-year medical students therein. • Uncertainty/inexperience of students.

Sample quotation • “When discharged from hospital, had to wait for a doctor for 3.5 hours, as students couldn’t authorize this themselves.” • “It would have been good to have had the clinical education ward and its divergences pointed out, before the conversation with the students … takes place.“ • “Final-year medical student was kind, but is understandably unexperienced, so I was a little disappointed.”

Topics of positive responses (n = 44)• Competence, commitment, professional, and considerate attitude of students. • Good and continuous availability. • Extensive, informative, and understandable communication. • Intensive exchange and cooperation with physicians. • Leading to deeper understanding of patients condition and treatment and to comprehensive and personal care.

Sample quotation • “The intensive care of one of the students was something quite new to me (eight surgeries, a lot of hospital stays). I found it quite pleasant and very good.” • “As students could spend a lot of time with me, I could evaluate my situation a lot better and almost all questions could be asked and answered, it was especially possible to raise new questions and to develop answers.“ • “The informative and warmhearted attention by medical students.” • “As I knew that everything would be internally discussed (with the doctors) and that they would also talk it over with me, the feeling of being well taken care of was even strengthened.“ • “The care and attention with which the diagnoses were made and how, in spite of all of that, one was involved, also that one was continually being asked how one found one or other medicine or application – and was taken seriously. One wasn’t forced to do anything one didn’t agree with or didn’t want to do.” • “The detailed biographical and physical history, even if, unfortunately, not everything could be dealt with if it wasn’t acute (e.g. knee). The time, attention, and interest of the learning doctor.”