To the Editor: The recent article by Olson et al1 and the accompanying editorial by Crotty2 confirm the impressions of anyone who has graduated from an Australian medical school within the past 30 years.

The paucity of clinical cases has probably been more significant in teaching hospitals in cities larger than Newcastle (where Olson and colleagues are based), as there has traditionally been a preponderance of student teaching in such institutions. This is something that seems to be slowly fading as new medical schools emerge in smaller cities, such as Canberra.

What is harder to measure is the time and angst associated with the process of determining which patients are accessible for medical students. Students can be frustrated not only by the concerns of the nursing staff, but also by paramedics, technicians, clerks, relatives, other students and, perhaps most discouraging of all, patients themselves.

Once this minefield of obstacles is negotiated, interaction with the patients is highly variable in terms of the learning opportunities afforded. Perversely, the most “valuable” patients in this sense can sometimes be the least accessible as they spend so much of their time away from the ward undergoing investigations. Crotty’s call to expand clinical teaching into the private sector has some merit, particularly as supervising consultants would be keen to make the student–patient interaction relatively efficient. I believe a more concerted effort to tap into the clinical resources in the expanded ambulatory sector is also required. Whatever “solutions” are found, it is hard to imagine that the clinical exposure of senior medical students to patients will be adequate any time soon.