The road towards, through, and beyond medical school is bumpy and arduous. The highs and lows that individuals face on their path towards becoming a physician test every aspect of their character. Not only does one have to be an excellent student and have an aptitude for embracing the profoundly difficult didactic portion of medical education, they also must be able to interact with real, articulate, human beings that are their patients. No matter how great an individual may be at learning information and passing exams, their success as a doctor will be dictated by how they interact with their patients, and how they provide care in an efficient, respectful, straight-forward manner that a patient can understand. In order to accomplish this, prospective physicians must begin learning these skills during medical school. This means that they are interacting with and treating real patients. Therefore, there are many ethical considerations at play here. Generally speaking, how receptive are patients to being treated by a medical student while a physician is only there for reference and guidance? As a patient, would you feel comfortable divulging your medical information to an individual who isn’t a licensed provider? What are the ethical considerations surrounding medical student patient care? Much research has been conducted in order to seek the answers to these ethical questions.
It is paramount to consider the ethical principles surrounding the role of medical students delivering patient care. First and foremost, it is within the patient’s right to autonomy to be informed that a medical student will be present and conducting an examination of the patient. This allows the patient to make their own, informed decision of whether they feel comfortable allowing medical students to perform these actions. Furthermore, the type of consultation and reasoning for medical intervention also plays a significant role in determining patient comfortability. In fact, a study done by Ryder et al., showed that a majority of patients interviewed in a sexual health clinic were uncomfortable with the presence of a medical student. This was especially true for patients who were either unfamiliar with what medical students do, or had no previous contact with a medical student (Ryder et al., 2005). It cannot be denied that the role of teaching medical students in a clinical setting is invaluable, but one must consider the circumstances and always default to respecting patient autonomy and preference.
In general, there are plenty of positive receptions to medical students being present in clinical settings, and even medical students performing consultations with a physician present. Another study performed by Shah-Khan et al., (2007) in an outpatient colorectal surgery clinic found that 81% of the participants accepted the presence of the medical students, for reasons that include the vitalness in teaching future doctors. The 19% disapproval stemmed from reasons regarding patient confidentiality, and a lack of confidence due to inexperience (Shah-Khan et al., 2007). Plenty of other studies have shown that patients are generally positively responsive to the presence of medical students in clinical settings, essentially describing the context of the situation as “they have to learn”. Teaching medical students in clinical settings is crucial for proper development towards becoming an effective physician, and thankfully, patients are generally receptive to this. However, we must consider that the autonomy and beneficence of patients must come first, and so it is important to consider the limitations of the presence of medical students in certain clinical settings as well.
References:
Ryder N, Ivens D, Sabin C. The attitude of patients towards medical students in a sexual health clinic. Sex Transm Infect. 2005 Oct;81(5):437-9. doi: 10.1136/sti.2004.014332. PMID: 16199748; PMCID: PMC1745034.
Shah-Khan M, Chowdhry S, Brand MI, Saclarides TJ. Patient attitudes toward medical students in an outpatient colorectal surgery clinic. Dis Colon Rectum. 2007 Aug;50(8):1255-8. doi: 10.1007/s10350-007-0274-x. PMID: 17587085.
I feel that is essential for medical students to have the opportunity to study under a physician that is only there for reference and guidance. It is essential to make sure a physician can think and act in an environment with patients on their own, i believe i am part of the 81% that believes it is vital in the teaching of future doctors. I previously was a CNA and you are unable to be certified unless you've shadowed for a certain amount of hours under other CNAs in order to ensure you are able to perform your learned skills and work in the environment with real patients. The supervision of the physician to the medical student is a key factor in providing proper patient care because it ensures that the medical student has a reference that can assist if needed.
ReplyDeleteI believe that it is extremly important for medical students to be able to have these experiences under the supervision of a licensed physician. This is because if they do not have these experiences early on in their education, they do not know what to do when they themselves are licensed physicians and are by themselves. This gets rid of the inexperience argument, which is also not very relevent because there is always an attending physician who is the one that is actually providing the care for the patient. Medical students must also declare themselves as such and get permission from the patient, so there is no ethical dilemma in this regard. Medical students also fall under HIPPA, so the patient's confidentiality is kept intact.
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