&&Patient InterestPatient InterestEducational InterestEducational Interest

FactFact

MedEd need pt. contactMedEd need pt. contact pt. feel positive to participatept. feel positive to participate

not alwaysnot always

ResearchResearch

ward: Med, Sx, OBward: Med, Sx, OB 114 sample, questionnaire114 sample, questionnaire result: result:

mean age 47.9mean age 47.9 M : F = 45.6 : 54.4M : F = 45.6 : 54.4 lower socioeconomiclower socioeconomic hospital stay 3-7 dhospital stay 3-7 d

Result Result

32.5% : student = doctor32.5% : student = doctor positive attitudepositive attitude

> 85% to Hx and PE> 85% to Hx and PE ventilate | supportive | informative | non-diventilate | supportive | informative | non-di

scriminatescriminate 75.4% to bedside teaching75.4% to bedside teaching

attention | understanding | communicationattention | understanding | communication

ResultResult

negative attitudenegative attitude 22-24% : procedure & competence22-24% : procedure & competence

confidence | skillful | supervisionconfidence | skillful | supervision 21% : advice21% : advice

short duration | practicalityshort duration | practicality

Result: GenderResult: Gender

male ptmale pt 84.6% : any gender84.6% : any gender

female ptfemale pt 40.3% : female student40.3% : female student 56.5% : any gender56.5% : any gender

Result: Why participate ?Result: Why participate ?

better quality of treatmentbetter quality of treatment more caremore care more informationmore information more contact timemore contact time

Result: Factors Affect AttitudeResult: Factors Affect Attitude

positivepositive older (> 60yr)older (> 60yr) lower education (1lower education (1ryry school) school)

FactFact

MedEd need pt. contactMedEd need pt. contact pt. feel positive to participatept. feel positive to participate

not alwaysnot always

FactFact

Pt. have the right to choosePt. have the right to choose pt. exercise their rightpt. exercise their right pt. right is violatedpt. right is violated

no informed consentno informed consent late permission sought, difficult to late permission sought, difficult to

refuserefuse

Why avoid informed consent?Why avoid informed consent?

myth: negatively affect the pt myth: negatively affect the pt decisiondecision research: randomized trialresearch: randomized trial

same participationsame participation increase satisfactionincrease satisfaction

myth: time restrictionmyth: time restriction didn’t need much timedidn’t need much time

Barrier to ParticipationBarrier to Participation nature of pt. problemnature of pt. problem previous bad experienceprevious bad experience negative preconceptionnegative preconception

level of confidentialitylevel of confidentiality student statusstudent status

lack of choicelack of choice not enough time to thinknot enough time to think

staff behavior staff behavior && communication communication

What increase satisfaction?What increase satisfaction?

earlier notificationearlier notification more specific informationmore specific information allowing them to see the doctor allowing them to see the doctor

alonealone

Detail to InformDetail to Inform

What?What? student: sex, number, statusstudent: sex, number, status level of confidentiality: level of confidentiality: medical notemedical note what will be done..what will be done..

Where? without student being presentWhere? without student being present When? earliestWhen? earliest How? How? verbal | document | signatureverbal | document | signature By whom? trained staffBy whom? trained staff

ExampleExample

1. The clinic was involved in the clinical training of 1. The clinic was involved in the clinical training of medical studentsmedical students

2. The training of future doctors depended on the 2. The training of future doctors depended on the participation of patientsparticipation of patients

3. The skill of the gynecologist whom the pt. would 3. The skill of the gynecologist whom the pt. would meet resulted from previous pt. participation in meet resulted from previous pt. participation in trainingtraining

4. Participation in the training was strictly voluntary4. Participation in the training was strictly voluntary

Students’ View: Unethical ActStudents’ View: Unethical Act

felt pressure to act unethicallyfelt pressure to act unethically 47% (48/103)47% (48/103) 35% (17/48) : conflict between medical 35% (17/48) : conflict between medical

education and patient careeducation and patient care witness a clinical teacher act witness a clinical teacher act

unethicallyunethically 61%61%

PolicyPolicy

students are not doctorstudents are not doctor verbal informed consentverbal informed consent pt under GA | incompetentpt under GA | incompetent procedure: consent procedure: consent && supervision supervision confidentialityconfidentiality refuse unethical actrefuse unethical act