Med student training

JAMA REPORTS (Medical Education Theme Issue)

Contact: George Stamatis, 216-368-3635, gxs18@po.cwru.edu

Posted September 3

MEDICAL STUDENTS DO NOT HINDER FAMILY PRACTICE VISITS

But students more likely to see poorer and minority patients

CHICAGO -- Physicians in community-based family practices spend about the same amount of time with patients, and patients are no less satisfied when medical students are involved in the visit, according to an article in the September 3 issue of The Journal of the American Medical Association (JAMA) -- a theme issue on medical education.

Scott H. Frank, M.D., M.S., from Case Western Reserve University in Cleveland, and colleagues analyzed records of visits to 16 community-based family practice offices in the area around Cleveland and Youngstown, Ohio. Among 452 visits observed, 83 visits included medical students; 369 did not. The observers in each case looked at the physician's behavior and used a checklist to report on services delivered during the visit. The participating patients completed an exit questionnaire.

They write: "Student involvement with patient visits did not decrease total patient satisfaction with the encounter."

The researchers also found no significant difference in the total time spent with the patient by the physician, but they report the time was allocated differently during visits when medical students were involved: "Physicians spend more time setting visit expectations and address health problems in other family members more often. They spend less time in history-taking, evaluation feedback, and answering questions."

The researchers report medical students were significantly more likely to see poorer and minority patients. They write: "There is no justification for non-white racial groups to sustain a disproportionate number of teaching visits. It is hoped that sensitivity to this tendency is raised by this finding and that physicians attempt to be egalitarian in the distribution of their teaching visits."

Among the other findings of the study:

* There was no significant difference in time spent by physicians in treatment planning, physical examination, or health education.

* Students were not involved in a greater percentage of visits resulting in laboratory tests or prescriptions.

* Referrals to another doctor occurred during a slightly greater percentage of visits when medical students were involved.

That patients registered as much satisfaction with their visit when students were present is encouraging -- as is the finding that no more than the usual number of laboratory tests were ordered or prescriptions written, according to Charlene Breedlove, M.A., JAMA contributing editor.

Previous studies have shown that when physicians were teaching medical students in community practices, they saw fewer patients -- and thus, produced less income.

This study did not address the issue of patient volume or overall length of patient care sessions, but the researchers point out: "It is reassuring that with the decreased time efficiency demonstrated in other studies, patient satisfaction with waiting time and with the amount of time spent with them by the physician does not change. Although the workday may lengthen, the patient does not appear to suffer as a result of lost attention from the physician."

(JAMA. 1997;278:712-716)

This study was supported by a grant from the National Cancer Institute, and by a Robert Wood Johnson Generalist Physician Faculty Scholars Award to a co-author.