Patient participation in, and attitudes towards, community-based medical education

Dear Sir

The training of future doctors relies on their learning in real clinical environments. In Australia the dominant clinical training sites are public teaching hospitals, however community-based medical education is increasingly recognised as an alternative to in-hospital training.

Australian health care is provided through either publically-funded teaching hospitals, or privately provided services in specialist and general practice. Private health services attract a government (Medicare) rebate, but often require a patient co-payment. This public–private divide has created an ethos that private (i.e. paying) patients would not accept the presence of medical students, despite previous studies reporting positive patient perceptions.

The authors surveyed 681 patients attending for private health care to determine whether there was a basis for this ethos. We found that 96% of respondents either had agreed or would agree to the presence of a student, and 46.7% said that they enjoyed, or would enjoy, contributing to the student's education. The majority of respondents (473 or 72.1%) agreed that the presence of a medical student is okay whether in private or public health care settings, while only 6.1% actively disagreed.

While previous surveys, mostly done in general practice, have shown that patients are generally willing to accept medical students (Chipp 2004, Hudson 2010), this study shows that such acceptance is not limited to general practice or publicly funded health care. We have clearly demonstrated that private health care is not a barrier to clinical teaching from the patient perspective, and confirmed previous findings regarding the need for clear consent, and the high regard patients have for doctors who teach.

A further finding from our research was the willingness of 32.8% of respondents to attend at a convenient time to help students in their learning. This is an important factor for the design of different teaching methods in private practice, allowing structuring of teaching rather than relying on serendipitous presentations. The clinical supervisor would not need to be physically present for the entire duration of the learning episode, and patients would have more active involvement in the clinical education process.

In summary, this study demonstrates that private health care is not a barrier to clinical teaching from the patient perspective. Patients are willing to allow medical students to be involved during their health care in private practice settings whether general or specialist practice. There is therefore potential to develop more learning opportunities in private health care settings.