Attitudes and perspectives of patients toward medical trainees

Abstract

The receptiveness of patients towards involving medical trainees in their care is essential to clinical education. Data on patients’ attitude towards trainees and reasons for their attitude is currently lacking. Hence the aim was to explore the attitudes and factors influencing the attitudes of patients towards trainees at a tertiary centre for cardiovascular care. A cross-sectional survey was performed among consecutive patients from the cardiac clinics at our tertiary institution in 2014. Of the 723 patients included, nearly all (97.9%) believe that senior doctors make the final decision for their care, and the majority (94.1%) are willing to interact with trainees under supervision of senior doctors. However, less than 60% of patients have actually allowed trainees to participate in their care most or all of the time, with the most important reason for this being fear that care would be compromised (n = 172). Top reasons why trainees were allowed include belief that it is important for trainees to get experience (n = 538), that trainees obtained permission politely (n = 360) and that trainees were professional (n = 284). Multivariate analysis revealed that better education (odds ratio (OR) 2.055, 95% confidence interval (CI) 1.393–3.033, p < 0.01), male gender (OR 1.556, 95% CI 1.058–2.338, p = 0.03) and less worry about cost of treatment (OR 1.605, 95% CI 1.058–2.433, p = 0.03) increased receptiveness towards trainees. The study demonstrated largely positive attitudes towards trainees being involved in one’s care. The trainee’s politeness and professionalism, as well as the patient’s perceived importance of trainee education, were important in determining such receptiveness.

Introduction

Medical training is built on the foundation of patient interaction. ¹ Sir William Osler famously declared that ‘To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.’ Yet, this essential bedside educational experience hinges on the willingness of patients to interact with trainees. The aim of this study was to understand the patient’s attitudes towards trainees, reasons for these attitudes, and the factors influencing these.

Methods

A cross-sectional survey was conducted among consecutive patients from the outpatient cardiac clinics at our tertiary institution over 2 months in 2014. The survey included questions on demographics as well as patients’ attitudes towards medical trainees and the underlying reasons for these attitudes. For the purpose of this study, the term trainees included medical students and junior doctors in training.

Results

A total of 723 patients were included. The large majority of patients believed that senior doctors make the final decision for their care (n = 708, 97.9%), and were willing to interact with trainees under supervision of a senior doctor (n = 680, 94.1%) However, almost half (n = 330, 45.6%) felt that their care will be compromised if a trainee was involved and only 57.7% (n = 417) of patients have allowed trainees to participate in their care most or all of the time. The most often cited reasons for patients allowing trainees to participate in their care include the belief that it is important for trainees to get experience, that trainees asked for permission politely and that trainees were professional (Figure 1). Fear that one’s care would be compromised was the most cited reason for rejecting trainees if approached (n = 172, 23.8%).

Figure 1.

Patients’ rationale for allowing medical trainees to participate in their care.

On multivariate analysis, significant factors predicting increased receptiveness to trainees included higher level of education (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.39–3.03, p < 0.01), male gender (OR 1.56, 95% CI 1.04–2.39, p = 0.03) and less concern about the cost of treatment (OR 1.60, 95% CI 1.06–2.43, p = 0.03).

Discussion

Understanding the reasons for allowing trainees to participate in patient care is paramount in improving interactions between trainees and patients. In our study, a trainee’s politeness and professionalism as well as the patient’s perceived importance of allowing the trainee to gain experience were important in determining such receptiveness. These are areas worth emphasising on. Medical professionalism is an essential trait to be instilled in medical trainees, and locally our medical schools are increasingly emphasizing professionalism and communication skills as part of the curriculum. ²

Given that 45.6% of patients believed that their care would be compromised with trainee involvement, it could be worthwhile for senior doctors to reassure their patients that their medical care would not be jeopardised and in fact, potentially enhanced with the input from trainees. Studies have shown better mortality outcomes for common conditions in major teaching hospitals compared with non-teaching hospitals. ³

Interestingly, male gender, a higher socioeconomic status and less worry about the cost of treatment were significantly associated with increased receptiveness towards trainees. Postulations include males having less worry about the physical examination (highlighting the importance of ensuring a patient’s privacy and modesty) and more educated patients realising the importance of training the younger generation of physicians (in line with our earlier findings).

Conclusion

In conclusion, this study provides a deeper understanding of the patient’s perspective towards medical trainees, highlighting possible areas that educators and training institutions can focus on to optimize the clinical experience that trainees and patients receive.