Patients don't mind inexperienced students

Karen Hebert, Bristol

Medical students' inexperience in performing minor procedures does not put patients off giving their consent to undergoing the procedure, a study has found (Medical Education 2005;39:365-9). Sally Santen and colleagues from Vanderbilt University Medical Center in Nashville found that 90% of patients gave their consent to a medical student performing a minor procedure on them, even when informed that it was the student's first time.

The researchers recruited 114 patients needing minor procedures, such as intravenous access, splinting, suturing, and six first year clinical medical students to carry them out. They first surveyed the patients about their perceptions of medical students performing procedures. Only 48% of participants knew they could be the first patient on whom a medical student might perform a procedure. Two thirds (66%) thought that they should be told if a student was performing his or her first procedure on them.

They gave the students a script saying to introduce themselves as first year students and gave a brief description of the training pathway of doctors. The students then explained the risks and benefits of the procedure itself and told the patient whether they had performed the procedure before and if so, how many times. The students also stressed that should a patient give their consent, they would be supervised by an experienced doctor.

Overall, 86% gave their consent for intravenous access; 100% for splints and 93% for sutures. In 7 of the 12 refusals, it was the student's first time performing the procedure.

Dr Santen explained, "This study is one of a series of questions we have been asking in terms of patient awareness of medical care provided by physicians in training. Nearly all of the literature is theoretic, meaning they ask the patient if theoretically they could perform the procedure. So we came up with what we considered at the time to be a provocative study. Tell the patients how much training the physician in training has, then ask the patient to consent."

"Our patients were very receptive to students learning. A number of patients told the students they could try again if they missed the IV. In previous studies of our patients, the patients do not know that Vanderbilt is a teaching hospital. So they do not come here with the expectation of students practicing," Dr Santen said. "What I have found, is that as long as the student is supervised patients are perfectly willing and want to help the students. I think that is why we had such a surprisingly high consent rate."

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She added, "One of the reasons physicians in training do not disclose their training status is that they are afraid that patients will refuse." However, she hopes the results of this study will allay such fears. "We think that students can be confident in truth telling without the concern that their training will be sacrificed.



studentBMJ 2005;13:177-220 May ISSN 0966-6494