Impact on patients of expanded, general practice based, student teachi
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《英国医生杂志》
1 General Practice and Primary Care Research Unit, Institute of Public Health, Cambridge CB2 2SR, 2 Eastern Deanery, Cambridge CB1 5EE, 3 Discipline of General Practice, University of Western Australia, Claremont, Perth, WA 6010, Australia
Correspondence to: J Benson jab62@medschl.cam.ac.uk
Objectives To compare patients' enablement and satisfaction after teaching and non-teaching consultations. To explore patients' views about the possible impact that increased community based teaching of student doctors in their practice may have on the delivery of service and their attitudes towards direct involvement with students.
Design Observational study using validated survey instruments (patient enablement index—PEI, and consultation satisfaction questionnaire—CSQ) administered after teaching consultations and non-teaching consultations. Ten focus groups (two from each practice), comprising five with patients participating in prearranged teaching sessions and five with patients not participating in these.
Setting Five general practices in west Suffolk and southern Norfolk, England, that teach student doctors on the Cambridge graduate medical course.
Participants 240 patients attending teaching consultations (response rate 82%, 196 patients) and 409 patients attending non-teaching consultations (response rate 72%, 294 patients) received survey instruments. Ten focus groups with a total of 34 patients participating in prearranged teaching sessions and 20 patients not participating in these.
Main outcome measures Scores on the patient enablement index and consultation satisfaction questionnaire, analysed at the level of all patients, allowing for age, sex, general practitioner, and practice, and at the level of the individual general practitioner teacher. Qualitative analysis of focus group data.
Results Patients' enablement or satisfaction was not reduced after teaching consultations compared with non-teaching consultations (mean difference in scores on the patient enablement index and consultation satisfaction questionnaire with adjustment for confounders 2.24% and 1.70%, respectively). This held true for analysis by all patients and by general practitioner teacher. Qualitative data showed that patients generally supported the teaching of student doctors in their practice. However, this support was conditional on receiving sufficient information about reasons for doctors' absence, the characteristics of students, and the nature of teaching planned. Many patients viewed their general practice as different from hospital and expected greater control over students' presence during their consultations.
Conclusions Patients' enablement and satisfaction are not impaired by students' participation in consultations. Patients generally support the teaching of student doctors in their general practice but expect to be provided with sufficient information and to have a choice about participation, so they can give informed consent. Recognising this when organising general practice based teaching is important.
Heads of Departments of Primary Care in the Medical Schools of the United Kingdom. New century: new challenges. 2002. www.sapc.ac.uk/docs/Mackenzie2.pdf (accessed 25 Feb 2005).
Coleman K, Murray E. Patients' views and feelings on the community-based teaching of undergraduate medical students; a qualitative study. Fam Pract 2002;19: 183-8.
Stacy R, Spencer J. Patients as teachers: a qualitative study of patients' views on their role in a community based undergraduate project. Med Educ 1999;33: 688-94.
Jones S, Oswald N, Date J, Hinds D. Attitudes of patients to medical student participation: general practice consultations on the Cambridge community-based clinical course. Med Educ 1996;30: 14-7.
Howe A, Anderson J. Involving patients in medical education. BMJ 2003;327: 326-8.
Howie J, Heaney DJ, Maxwell M, Walker JJ. A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultation. Fam Pract 1998;15: 165-71.
Baker R. Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations. Br J Gen Pract 1996;46: 601-5.
Kinnersley P, Stott N, Peters T, Harvey I, Hackett P. A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract 1996;13: 41-51.
Mead N, Bower P, Hann P. The impact of general practitioners' patient-centredness, on patients' post-consultation satisfaction and enablement. Soc Sci Med 2002;55: 283-99.
Rees Lewis J, Williamson V. Examining patient perceptions of quality care in general practice: comparison of quantitative and qualitative methods. Br J Gen Pract 1995;45: 249-53.
Laird N, Ware J. Random-effects models for longitudinal data. Biometrics 1982;38: 963-74.
Pinheiro J, Bates D. Mixed-effects models in S and S-PLUS. New York: Springer, 2000.
R Development Core Team. R: A language and environment for statistical computing. R Vienna: Foundation for Statistical Computing, 2004.
O'Flynn N, Spencer J, Jones R. Consent and confidentiality in teaching in general practice: survey of patients' views on presence of students. BMJ 1997;315: 1142.
Balint M. The doctor, his patient and the illness. Edinburgh: Churchill Livingstone, 1986.
Cooke F, Galasko G, Ramrakha V, Richards D, Rose A, Watkins J. Medical students in general practice: how do patients feel? Br J Gen Pract 1996;46: 361-2.
Bentham J, Burke J, Clark J, Svoboda C, Vallance G, Yeow M. Students conducting consultations in general practice and the acceptability to patients. Med Educ 1999;33: 686-7.
Tarrant C, Windridge K, Boulton M, Baker R, Freeman G. Qualitative study of the meaning of personal care in general practice. BMJ 2003;326: 1310-8.
O'Flynn N, Rymer J. Women's attitudes to the sex of medical students in a gynaecological clinic: cross sectional survey. BMJ 2002;325: 683-4.
Williamson C, Wilkie P. Teaching medical students in general practice: respecting patients' rights. BMJ 1997;315: 1108-9.
Doyal L. Closing the gap between professional teaching and practice. BMJ 2001;322: 685-6.(John Benson, director, general practice )
Correspondence to: J Benson jab62@medschl.cam.ac.uk
Objectives To compare patients' enablement and satisfaction after teaching and non-teaching consultations. To explore patients' views about the possible impact that increased community based teaching of student doctors in their practice may have on the delivery of service and their attitudes towards direct involvement with students.
Design Observational study using validated survey instruments (patient enablement index—PEI, and consultation satisfaction questionnaire—CSQ) administered after teaching consultations and non-teaching consultations. Ten focus groups (two from each practice), comprising five with patients participating in prearranged teaching sessions and five with patients not participating in these.
Setting Five general practices in west Suffolk and southern Norfolk, England, that teach student doctors on the Cambridge graduate medical course.
Participants 240 patients attending teaching consultations (response rate 82%, 196 patients) and 409 patients attending non-teaching consultations (response rate 72%, 294 patients) received survey instruments. Ten focus groups with a total of 34 patients participating in prearranged teaching sessions and 20 patients not participating in these.
Main outcome measures Scores on the patient enablement index and consultation satisfaction questionnaire, analysed at the level of all patients, allowing for age, sex, general practitioner, and practice, and at the level of the individual general practitioner teacher. Qualitative analysis of focus group data.
Results Patients' enablement or satisfaction was not reduced after teaching consultations compared with non-teaching consultations (mean difference in scores on the patient enablement index and consultation satisfaction questionnaire with adjustment for confounders 2.24% and 1.70%, respectively). This held true for analysis by all patients and by general practitioner teacher. Qualitative data showed that patients generally supported the teaching of student doctors in their practice. However, this support was conditional on receiving sufficient information about reasons for doctors' absence, the characteristics of students, and the nature of teaching planned. Many patients viewed their general practice as different from hospital and expected greater control over students' presence during their consultations.
Conclusions Patients' enablement and satisfaction are not impaired by students' participation in consultations. Patients generally support the teaching of student doctors in their general practice but expect to be provided with sufficient information and to have a choice about participation, so they can give informed consent. Recognising this when organising general practice based teaching is important.
Heads of Departments of Primary Care in the Medical Schools of the United Kingdom. New century: new challenges. 2002. www.sapc.ac.uk/docs/Mackenzie2.pdf (accessed 25 Feb 2005).
Coleman K, Murray E. Patients' views and feelings on the community-based teaching of undergraduate medical students; a qualitative study. Fam Pract 2002;19: 183-8.
Stacy R, Spencer J. Patients as teachers: a qualitative study of patients' views on their role in a community based undergraduate project. Med Educ 1999;33: 688-94.
Jones S, Oswald N, Date J, Hinds D. Attitudes of patients to medical student participation: general practice consultations on the Cambridge community-based clinical course. Med Educ 1996;30: 14-7.
Howe A, Anderson J. Involving patients in medical education. BMJ 2003;327: 326-8.
Howie J, Heaney DJ, Maxwell M, Walker JJ. A comparison of a patient enablement instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultation. Fam Pract 1998;15: 165-71.
Baker R. Characteristics of practices, general practitioners and patients related to levels of patients' satisfaction with consultations. Br J Gen Pract 1996;46: 601-5.
Kinnersley P, Stott N, Peters T, Harvey I, Hackett P. A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract 1996;13: 41-51.
Mead N, Bower P, Hann P. The impact of general practitioners' patient-centredness, on patients' post-consultation satisfaction and enablement. Soc Sci Med 2002;55: 283-99.
Rees Lewis J, Williamson V. Examining patient perceptions of quality care in general practice: comparison of quantitative and qualitative methods. Br J Gen Pract 1995;45: 249-53.
Laird N, Ware J. Random-effects models for longitudinal data. Biometrics 1982;38: 963-74.
Pinheiro J, Bates D. Mixed-effects models in S and S-PLUS. New York: Springer, 2000.
R Development Core Team. R: A language and environment for statistical computing. R Vienna: Foundation for Statistical Computing, 2004.
O'Flynn N, Spencer J, Jones R. Consent and confidentiality in teaching in general practice: survey of patients' views on presence of students. BMJ 1997;315: 1142.
Balint M. The doctor, his patient and the illness. Edinburgh: Churchill Livingstone, 1986.
Cooke F, Galasko G, Ramrakha V, Richards D, Rose A, Watkins J. Medical students in general practice: how do patients feel? Br J Gen Pract 1996;46: 361-2.
Bentham J, Burke J, Clark J, Svoboda C, Vallance G, Yeow M. Students conducting consultations in general practice and the acceptability to patients. Med Educ 1999;33: 686-7.
Tarrant C, Windridge K, Boulton M, Baker R, Freeman G. Qualitative study of the meaning of personal care in general practice. BMJ 2003;326: 1310-8.
O'Flynn N, Rymer J. Women's attitudes to the sex of medical students in a gynaecological clinic: cross sectional survey. BMJ 2002;325: 683-4.
Williamson C, Wilkie P. Teaching medical students in general practice: respecting patients' rights. BMJ 1997;315: 1108-9.
Doyal L. Closing the gap between professional teaching and practice. BMJ 2001;322: 685-6.(John Benson, director, general practice )