Attitudes of a private hospital community to medical student teaching

To the Editor: A shortage of training opportunities for medical students in public hospitals has led to greater need for collaboration with the private sector.1-3 In 2011, Sydney Medical School established the first private hospital clinical school in New South Wales at the Sydney Adventist Hospital (SAH). Essential to its success is the support of the hospital’s patient and medical community.

We conducted two cross-sectional surveys, adapted from previous research, to assess attitudes toward participation in medical student teaching among SAH patients and staff.4 Between August and October 2011, hospital volunteers recruited patients and staff from all departments on various days, but did not record refusals. We included visitors if they were previous or potential future patients. Doctors had limited time for completing the survey while seeing patients, so we sent them the survey by email. The SAH Human Ethics Research Committee approved the study.

A total of 283 surveys were completed by inpatients (52%), outpatients (30%) and visitors (18%). Sixty-seven per cent of survey participants were women. Patients were categorised as surgical (75%), medical (49%) or gynaecological (19%). More than half the patients had a tertiary education (53%). Among staff, 143 surveys were completed by doctors (49%), nurses (46%) and allied health professionals (5%). Their time at SAH ranged from 1 year to > 10 years. Fifty-two per cent of the staff were women.

Most patients and staff (≥ 88%) agreed that they would allow students to observe during consultations or procedures (Box). Patients also desired the doctor’s constant presence, and time alone with the doctor. Over 56% of patients and 78% of staff indicated that they would accept more active student involvement in simple procedures or examinations. Patients were less accepting of students’ presence during intimate examinations or of students assisting in surgery.

These results support student teaching in a private hospital, with levels of cooperation exceeding those observed in a similar survey of private and public patients.5 Our findings may reassure those concerned that privately insured patients would not consent to participate in teaching. In fact, about half of SAH patients and staff agreed that they would like to have a student present.

Most of the patients and staff felt that the appearance or manner of students would affect their participation. These factors, along with presence of and time alone with the doctor, can be directly addressed to enhance the experiences of patients and doctors involved in student teaching. A hospital dress code for medical students exists, as does training in professionalism.

Lack of time for teaching is clearly an issue for SAH staff, as for public hospital staff. Assisting practitioners to incorporate efficient teaching into the private clinical arena is an area for future investigation.

The privilege of having private health insurance does not reduce the responsibility to contribute to the training of future doctors. Despite the limitations of this study, we have shown that patients and staff of a private hospital largely accept this responsibility. Reassessing actual levels of cooperation after exposure to medical students will be important.