Student doctors and women in labor: Attitudes and expectations

doi:10.1016/0029-7844(96)00191-3

Obstetrics & Gynecology

Volume 88, Issue 2, August 1996, Pages 298-302

https://doi.org/10.1016/0029-7844(96)00191-3 Get rights and content

Objective

To compare the attitudes and expectations that obstetric patients and medical students bring to the studentpatient relationship in intrapartum care.

Methods

Written questionnaires were distributed to obstetric patients who had students assist in their labor and delivery care and to medical students who had completed their clinical clerkship year. Responses of 222 patients and 67 students were analyzed for differences in expectations of student participation and assessment of skills.

Results

Responses of medical students and patients were significantly different in all attitudes and expectations studied. One hundred thirty-six (61%) patients compared with 27 (40%) students identified the patients' wish to contribute to the education of students as the most important reason for agreeing to student participation. All patients felt that student participation should be requested rather than assigned, with 194 (87%) patients but only 30 (45%) students wishing to have the student absent from the room at the time of the request. Mean ratings of different student skills tended to be higher from patients (1.3–1.8 on a seven-point Likert scale) than from the students themselves (range 1.6–2.4). Although students' expectations of participation in patient care were high, patients indicated expectations of fairly low levels of student involvement in communication, examination, labor support, and procedures.

Conclusion

Students have high expectations for their active involvement in intrapartum care and tend to underestimate the sense of altruism that motivates patients to allow student participation. Patients have low expectations of levels of student participation in their care, but are overall quite satisfied with the skills of the students. These differences highlight the need for the development of educational objectives that clarify student roles in clinical clerkships and the process of informed consent for student participation.

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To the Point: optimizing the learning environment in labor and delivery
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The labor and delivery floor is a unique learning environment that poses challenges to teaching medical students, with a potentially detrimental effect on their evaluations of the obstetrics and gynecology clerkship. This article, from the “To the Point” series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, offers specific suggestions for improving undergraduate medical education in obstetrics with attention to student preparation, faculty development, nonphysician staff involvement, and patient education. Optimizing the learning environment in labor and delivery would improve student experiences and perceptions of our specialty.
No. 246-Pelvic Examinations by Medical Students
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Patients have the right to refuse medical treat- ment and participation in medical teaching exercises. In fact, most patients are willing to participate in medical education5,11–15 but want to be informed of medical student involvement in their care.4,14,15 Physicians and students must be explicit about student participation during the consent process.16
Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations
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Although these trends may not carry over into other medical or surgical specialties, the important underlying point is that patients can be grouped into specific populations based on general characteristics that can be identified before any patient interaction, as done in our current study, and that based on these populations, assumptions can be made about their possible willingness to include medical trainees in their care. Regardless of patient predisposition to resident involvement, a 1996 study by Miller et al. reported that all patients believed trainee participation should be offered to the patient before resident inclusion rather than assumed to be acceptable by the attending physician.9 However, in this Miller study, once the request for inclusion was made, less than half of the patients preceded to decline student involvement.
The goal of residency programs is to provide trainees with exposure to all aspects of their chosen field so that they exit the program ready to be independent practitioners. However, it is common in some plastic surgery residency training programs to exclude residents from participation in consultations with patients who are seeking cosmetic surgery. The purpose of this study was to determine whether cosmetic surgery patients had a different view about resident involvement than reconstructive surgery patients and to evaluate what factors might be linked to patient attitudes on this topic.
Participants: All new patients older than 18 years presenting to either academic or nonacademic locations were asked to complete the voluntary survey at their initial consultation. Setting: The study was conducted at both the Ohio State University (academic) and Advanced Aesthetic and Laser Surgery (private practice) in Columbus, Ohio. Design: The survey asked patients to identify their surgical concern as either cosmetic or reconstructive and to indicate the location on their body where they were having surgery. Additionally, a series of statements regarding resident involvement was presented with a 5-point Likert-type rating system to assess each patient’s attitudes about a range of factors, such as resident sex and seniority.
In total, 119 patients participated in the study by completing the survey. Of this population, 59.7% (n = 71) were classified as reconstructive surgery patients and 40.3% (n = 48) were classified as cosmetic surgery patients. Based on responses, it was determined that reconstructive surgery patients were more approving of resident involvement in their care than cosmetic surgery patients were. When other factors were analyzed, the patients seeking breast surgery were found to be more apprehensive about resident participation than non–breast surgery patients were.
Although there were some differences in the way resident participation was perceived by cosmetic and reconstructive surgery patient populations, neither group strongly believed that resident participation decreased the quality of patient care. Based on these findings, plastic surgery training programs should begin to allow residents to become more involved in the care of cosmetic surgery patients.
Confidence in Performing Normal Vaginal Delivery in the Obstetrics Clerkship: A Randomized Trial of Two Simulators
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: To compare clerkship medical students’ confidence in performing a simulated normal vaginal delivery (NVD) after participating in a simulation training session using two different models.
: Medical students were randomized to participate in a simulated NVD session using either an obstetrics mannequin or a birthing pelvis model. Questionnaires were used to assess confidence and evaluate the simulation before and immediately after the session and on the last day of the obstetrics clerkship rotation.
: One hundred ten students were randomized. At the start of the clerkship, both groups had similar obstetrics exposure and confidence levels. Only 15 students (13.9%) agreed they were ready to attempt a NVD with minimal supervision or independently. This increased significantly to 43 students (39.4%) immediately after the session. At the end of the clerkship, 79 of 81 responding students (97.5%) were confident that they could attempt a NVD with minimal supervision or independently. There were no significant differences noted between simulator groups at any point. The sessions were rated as equally useful and realistic, and this remained unchanged at the end of the clerkship.
: Simulated NVD training using either an obstetrics mannequin or a birthing pelvis model provides clerkship students with a positive experience and increases confidence immediately. It should be implemented early in the rotation, as it appears the clerkship experience also plays a large role in terms of students’ confidence. Despite this, students maintain this type of learning is useful. Effective simulation training can easily be incorporated into clerkship training.
: Comparer la confiance des étudiants de médecine en stage clinique, pour ce qui est de l’exécution d’une simulation d’accouchement vaginal normal (AVN), à la suite de leur participation à une session de formation en simulation au moyen de deux modèles différents.
: Des étudiants de médecine ont été affectés, au hasard, à une session de simulation d’AVN faisant appel à un mannequin obstétrical ou à une session de simulation faisant appel à un modèle de bassin simulant l’accouchement. Des questionnaires ont été utilisés pour évaluer la confiance et la simulation avant et immédiatement après la session, ainsi qu’au cours de la dernière journée de la rotation en obstétrique.
: Cent dix étudiants ont été affectés au hasard à l’un ou l’autre des groupes de simulation. Au début du stage clinique, les deux groupes présentaient des niveaux de confiance et d’exposition à la pratique obstétricale semblables. Seulement 15 étudiants (13,9 %) étaient d’avis qu’ils étaient prêts à tenter un AVN de façon indépendante ou sous une supervision minimale. Cette proportion a connu une hausse considérable en passant à 43 étudiants (39,4 %) immédiatement après la session de simulation. À la fin du stage clinique, 79 des 81 étudiants répondants (97,5 %) étaient confiants de pouvoir tenter un AVN de façon indépendante ou sous une supervision minimale. Aucune différence significative n’a été constatée entre les groupes de simulation à quelque moment que ce soit. Les sessions ont été évaluées comme étant tout aussi utiles et réalistes les unes que les autres; cette constatation est demeurée la même à la fin du stage clinique.
: La formation faisant appel à la simulation d’un AVN au moyen d’un mannequin obstétrical ou d’un modèle de bassin simulant l’accouchement offre aux étudiants en stage clinique une expérience positive et accroît immédiatement leur confiance. Une telle formation devrait être mise en œuvre tôt au cours de la rotation, puisqu’il semble que l’expérience vécue au cours du stage clinique joue également un rôle important pour ce qui est de la confiance des étudiants. Peu importe la chronologie de la simulation, les étudiants soutiennent que ce type d’apprentissage leur est utile. Une formation efficace en simulation peut facilement être intégrée au stage clinique.
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^*: This work was supported by an Ortho-APGO Faculty Development Award 1990.

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Graduate educationStudent doctors and women in labor: Attitudes and expectations*

Objective

Methods

Results

Conclusion

Eval Program Plan

Soc Sci Med

Satisfaction with medical care, its measurement and relation to utilization

Med Care

Patient assessment of hospital care

Qual Rev Bull

Hospital structure and consumer satisfaction

Health Serv Res

Patients' views of the medical education setting

J Med Educ

Acceptance by private patients of resident involvement in their outpatient care

J Med Educ

Graduate education
Student doctors and women in labor: Attitudes and expectations*