TEACHING MEDICAL STUDENTS IN GENERAL PRACTICE THE PATIENTS VIEW

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TEACHING MEDICAL STUDENTS IN GENERAL
PRACTICETHE PATIENTS VIEW

• Asist. Nena Kopcavar Gucek
• Outpatient Clinic Zdravje
• Smoletova 18
• 1000 Ljubljana

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Teaching while working with patients is the
essence of medical education

• for students it means the trial of
  communiciation, connecting theory with practice
• for postgraduate students doctors / on the
  job lifelong teaching is the momentum of their
  professional development.

Asist. Nena Kopcavar Gucek
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The POSITIVE perspectives of theaching in general
practice (GP)

• the opportunity of using theoretical knowledge
• in a practical situation
• palpable , realistic situations
• professional contest
• motivation in team work
• teacher as the role model of empathy,
• clinical decision making, proffesionalism

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The NEGATIVE perspectives of teaching in general
practice ( GP )

• variable, rarely reconstructable situation
• lack of intellectual challenge, mundanity
• limited opportunity for supervision
• lack of time for explanation
• randomly chosen patients
• inadequate andragogic education
• of the teachers.

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Teaching in GP generally involves two important
processes

• 1. treating of the patient,
• 2. teaching of the student.
• Neither should be hindered / neglected
• by the other!

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Stages of work / levels of independance of a
student, workingy in GP

• 1. observing the teacher at work
• 2. working ander the teacher's supervision
• 3. working independently with the obligatory
  consultation decision making

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The RIGHTS OF THE PATIENT are an ethical
obligation, not to be neglected in the teaching
process

• 1. informed consent and information about the
  
• presence of the student ( right to choose
  )
• 2. the possibility of solo consultation with
  the
• teacher only ( privacy )
• 3. keeping the patient in the center of care
• 4. respecting all ethical obligations
• 5. doctor patient relationship remains in
  the
• center of teaching and research agendas

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If conducted properly with

• expertise,
• care,
• respect,
• teaching in general practice may benefit all
• the three participants
• the patient,
• the student and
• the teacher.

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ETHICAL ISSUES in teaching in general practice

• Inform the patients about students presence in
  advance.
• The patient's choice should not affect the
  outcome of consulation and the doctor/patient
  relationship.
• Choose the patient with simple physical problems
• Ensure the student respects ethical principles
• Instruct the patient of the learner's level of
  education and the purpose of his participation
  and role in teaching session.

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The CORNERSTONES of a successful consultation in
GP including a student present

• respect,
• candor,
• empathy,
• verbal and
• nonverbal communication.

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Reminders for the STUDENT-PATIENT COMMUNICATION
during the consultation

• include the patient actively
• importance of active listening,
• patient should give feed-back on the students
  performance,
• positive role of the student active listener, a
  curious an compassionate companion, unlimited
  time
• proper introduction of the student at the
  beginning of the consultation

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Survey about the impact of the presence of the
student on the consultation in GP ( Milosevic
2001 )

• 54 consecutive pts in GP
• annonymous questionnaire
• 10 questions with Lickert - type answers
• survey with self-administered
• questionnaire after the consultation

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Results (1)Upons seeing the student in the
GPs office, the pts were

• not surprised in 52
• pleasanlty surprised in 22
• non-pleasantly surprised in 2
• disturbed in 4

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Results (2)During the physical examination,
the presence of the student was for the patient

• non disturbing in 85
• pleasant in 6
• disturbing in 9

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Results ( 3 )The presence of the student in
the GPs office evoked the following feelings.

• 61 of the pts were unperturbed
• 33 liked or liked very much the
• presence of the student
• 6 disliked or strongly disliked the
• presence of the student

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Results (4)In thre presence of the student,
the pts evaluated the attentiveness of the GP
towards them as (compared to being alone with the
GP)

• the same in 78
• greater or much greater in 15
• smaller or much smaller in 7

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Results ( 5 )In the presence of the student,
the quality of care seemed to the pts ( compared
to being alone with the GP)

• same in 83
• bigger or much bigger in 13
• smaller or much smaller in 4

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ConclusionsTeaching in GP differs from teachin
in hospitals, but it is inevitable and invaluable.

• Communication is the basis of teacher-patient
  relationship and plays a major role in the
  teachingtriad patient doctor - student.
• Patients should be treated with respect,
  genuiness and empathy, whereby teachers act as
  role - models for the learners.
• In the teaching in GP, the patient remains in the
  center of the process and is given an active role.

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• The results of some studies suggest that the
  teaching process in medicine can be a positive
  and enjoyable experience for the patients as well
  as for the students and their mentors.

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learning is the only thing which the mind can
never exhaust, never alienate,
never be tortured by, never fear or
distrust and never dream of regretting.

T.H White
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Thank you for your attention