TEACHING MEDICAL STUDENTS IN GENERAL PRACTICE THE PATIENTS VIEW

TEACHING MEDICAL STUDENTS IN GENERAL PRACTICE

THE PATIENTS VIEW

Asist. Nena Kopčavar GučekOutpatient Clinic Zdravje

Smoletova 181000 Ljubljana

Teaching while working with patients is the essence of medical education:

• for students it means the trial of communiciation, connecting theory with practice;

• for postgraduate students – doctors / «on the job« lifelong teaching is the momentum of their professional development.

Asist. Nena Kopčavar Guček

The POSITIVE perspectives of theaching in general practice (GP):

• the opportunity of using theoretical knowledge

in a practical situation • » palpable «, realistic situations• professional contest• motivation in team work• teacher as the role model of empathy,

clinical decision making, proffesionalism


The NEGATIVE perspectives of teaching in general practice ( GP ) :

• variable, rarely reconstructable situation• lack of intellectual challenge, mundanity• limited opportunity for supervision• lack of time for explanation• randomly chosen patients• inadequate andragogic education

of the teachers.


Teaching in GP generally involves two important processes:

1. treating of the patient,

2. teaching of the student.

Neither should be hindered / neglected

by the other!


Stages of work / levels of independance of a student, workingy in GP:

1. observing the teacher at work

2. working ander the teacher's supervision

3. working independently with the obligatory consultation decision – making


The RIGHTS OF THE PATIENT are an ethical obligation, not to be neglected in the teaching process:

1. informed consent and information about the presence of the student ( right to choose )

2. the possibility of »solo« consultation with the teacher only ( privacy )

3. keeping the patient in the center of care

4. respecting all ethical obligations

5. doctor – patient relationship remains in the center of teaching and research agendas


If conducted properly with

• expertise,• care,• respect,

teaching in general practice may benefit allthe three participants: • the patient, • the student and• the teacher.


ETHICAL ISSUES in teaching in general practice

• Inform the patients about students presence in advance.

• The patient's choice should not affect the outcome of consulation and the doctor/patient relationship.

• Choose the patient with simple physical problems

• Ensure the student respects ethical principles

• Instruct the patient of the learner's level of education and the purpose of his participation and role in teaching session.


The CORNERSTONES of a successful consultation in GP including a student present:

• respect,

• candor,

• empathy,

• verbal and

• nonverbal communication.


Reminders for the STUDENT-PATIENT COMMUNICATION during the consultation:

• include the patient actively

• importance of active listening,

• patient should give feed-back on the studentś performance,

• positive role of the student: active listener, a curious an compassionate companion, unlimited time

• proper introduction of the student at the beginning of the consultation


Survey about the impact of the presence of the student on the consultation in GP ( Milosevic 2001 ):

• 54 consecutive pts in GP

• annonymous questionnaire

• 10 questions with Lickert - type answers

• survey with self-administered

questionnaire after the consultation


Results (1)

Upons seeing the student in the GP`s office, the pts were:

• not surprised in 52%

• pleasanlty surprised in 22%

• non-pleasantly surprised in 2%

• disturbed in 4%


Results (2)

During the physical examination, the presence of the student was for the patient:

• non disturbing in 85%

• pleasant in 6%

• disturbing in 9%


Results ( 3 )

The presence of the student in the GP`s office evoked the following feelings.

• 61% of the pts were unperturbed

• 33% liked or liked very much the

presence of the student

• 6 % disliked or strongly disliked the

presence of the student


Results (4)

In thre presence of the student, the pts evaluated the attentiveness of the GP towards them as (compared to being alone with the GP)

• the same in 78%

• greater or much greater in 15%

• smaller or much smaller in 7%


Results ( 5 )

In the presence of the student, the quality of care seemed to the pts ( compared to being alone with the GP):

• same in 83%

• bigger or much bigger in 13%

• smaller or much smaller in 4%


Conclusions:Teaching in GP differs from teachin in hospitals, but it is inevitable and invaluable.

• Communication is the basis of teacher-patient relationship and plays a major role in the teachingtriad patient – doctor - student.

• Patients should be treated with respect, genuiness and empathy, whereby teachers act as role - models for the learners.

• In the teaching in GP, the patient remains in the center of the process and is given an active role.


The results of some studies suggest that the teaching process in medicine can be a positive and enjoyable experience for the patients as well as for the students and their mentors.


»…learning is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust and never dream of regretting.« T.H White


Asist. Nena Kopčaver Guček 21

Thank you

for your attention

TEACHING MEDICAL STUDENTS IN GENERAL PRACTICE THE PATIENTS VIEW

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