This article was downloaded by: [Nipissing University] On: 17 October 2014, At: 05:48 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Teaching and Learning in Medicine: An International Journal Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/htlm20
Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan a
b
c
b
Kyoko Murata , Mio Sakuma , Susumu Seki & Takeshi Morimoto a
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan b
Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
c
Community Health Care, Hyogo College of Medicine, Nishinomiya, Japan Published online: 15 Oct 2014.
To cite this article: Kyoko Murata, Mio Sakuma, Susumu Seki & Takeshi Morimoto (2014) Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan, Teaching and Learning in Medicine: An International Journal, 26:4, 335-343, DOI: 10.1080/10401334.2014.945030 To link to this article: http://dx.doi.org/10.1080/10401334.2014.945030
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Teaching and Learning in Medicine, 26(4), 335–343 C 2014, Taylor & Francis Group, LLC Copyright ISSN: 1040-1334 print / 1532-8015 online DOI: 10.1080/10401334.2014.945030
Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan Kyoko Murata Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Mio Sakuma Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Susumu Seki Community Health Care, Hyogo College of Medicine, Nishinomiya, Japan
Downloaded by [Nipissing University] at 05:48 17 October 2014
Takeshi Morimoto Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Background: It is essential for medical students to interact directly with patients. However, patients may be reluctant to be seen by medical students in settings in which they may also be seen by senior staff. Purposes: To understand patients’ attitudes toward practice by medical students and consider the factors involved in obtaining patients’ cooperation, we conducted a nationwide crosssectional survey. Methods: We randomly selected 2,400 adult participants from all over Japan. Trained research assistants inquired about participants’ experiences and attitudes toward practice by medical students using a questionnaire. We compared differences in attitudes between participants who were accepting of practice by medical students and those who were not, as well as differences between participants who had experienced practice by a medical student versus those who had not. Results: A total of 1,109 (46%) participants were included in the study. Eleven percent (117/1109) of the participants had experienced practice by a medical student. One fourth of participants were accepting of practice by medical students, and experienced participants were significantly more likely to be accepting of practice by medical students than inexperienced participants (45% vs. 24%, p < .001). Impressions of practice by medical students among accepting participants with previous experiences included “polite,” “kind,” and “hard-working.” Fiftynine percent (637/1088) of participants indicated that they would request a senior staff member’s supervision when being seen by a medical student. Conclusions: The present nationwide survey suggests that education emphasizing bedside manner may be effective in promoting patients’ cooperation of medical students. In addition, providing information to patients about medical students and
We thank Ms. Makiko Ohtorii, Ms. Ai Mizutani, and Ms. Mika Sakai for their assistance with administration and data management. Correspondence may be sent to Takeshi Morimoto, Division of General Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan. E-mail: morimoto@ hyo-med.ac.jp
efforts to increase supervision during clinical clerkship should be emphasized to foster the public’s cooperation. Keywords
attitudes, clinical clerkship, medical students, general public, survey
BACKGROUND Interacting directly with patients is an integral aspect of clinical clerkship for medical students; however, patients may be reluctant to be seen by medical students in settings in which they have an equal opportunity to be examined by senior staff. Medical students thus face a considerable challenge in establishing good relationships with patients, as well as in effectively acquiring necessary skills through clinical clerkship. Real patients are a vital part of clinical training, as they bridge the gap between textbook learning and real-world medical practice.1 Traditionally, patients have played a relatively passive role, simply acting as teaching “materials,”2 and in the past patients remained largely unaware of the involvement of medical students in their care.3 More recently, however, the importance of obtaining the patient’s consent before the patient can be seen by a medical student increased. The complex matters of medical students’ right to clinical education and patients’ right to decline care from medical students may therefore come into conflict.1 Patients’ attitudes toward practice by medical students have yielded variable results in medical settings. One previous study found that patients were reluctant to be seen by medical students in the emergency department.4 Other studies have demonstrated that patients’ comfort levels with the involvement of medical students in their care appeared to differ based on several factors, including the sex of the medical student, the level of
335
336
K. MURATA, M. SAKUMA, S. SEKI, T. MORIMOTO
Downloaded by [Nipissing University] at 05:48 17 October 2014
involvement, and the student’s stage of training,5 and that patients’ cooperation was dependent on medical students’ competencies.6 In addition, the hospital or medical school where the student received his or her clinical training was also shown to be a significant factor.1 Medical students must be able to establish good relationships with patients in order to gain their support. This in turn gives medical students opportunities to practice their clinical skills in a real-world setting. In the present study, a nationwide survey was carried out in Japan in order to investigate attitudes toward practice by medical students and experiences of receiving care from medical students among the general public and to identify key factors that may foster public cooperation with clinical clerkships.
METHODS Participants and Setting A nationwide survey was conducted using a representative sample of 2,400 people (15–79 years old) selected from among the entire population (128 million residents) of Japan (M age = 43 years; 49% men [2005 population census]). Two hundred research assistants went door to door to conduct surveys with participants in March 2006.7 The participants were selected by multistage, stratified random sampling. Municipalities were selected at the first stage and specific areas were selected from each municipality at the second stage. Then participants were selected at equal intervals using a basic resident register. The research assistant visited each participant twice. At the initial visit, they asked participants to complete the paper questionnaire. They visited again to collect the questionnaire several days later. The demographics of participants were also obtained in the questionnaire. If the assistants could not contact the participants at the second visit, they were considered as refusing to participate. This study was approved by Kyoto University Graduate School and Faculty of Medicine Ethics Committee and informed consent was obtained from each participant. Questionnaire A questionnaire was developed to measure the general population’s attitudes toward clinical practice by medical students. Key questions addressed the experiences, impressions, and requirements associated with practice by medical students. Most questions had multiple-choice responses (see Appendix A). Eight nonmedically trained persons reviewed the questionnaire prior to the survey to improve its clarity and brevity. Measurements and Statistical Analyses Participants’ characteristics and data regarding the following experiences and attitudes toward practice by medical students were obtained: (a) experience of practice by a medical student, (b) acceptance of practice by medical students and its reasons for acceptance, and (c) demands regarding medical education
that must be met before the participant would accept practice by medical students. For participants with the experience of being seen by a medical student, we asked the following additional questions: (a) the situation and contents of the practice, (b) satisfaction level with the practice, and (c) length of time that a supervising senior staff member was present (see Appendix A). Participants with experience of practice by a medical student were defined as a participant or participant’s family member who had ever seen by a medical student. A participant’s spouse, parent, grandparent, sibling, child, or grandchild was included as a family member. Those who answered “No/I am not sure” were defined as inexperienced. Participant’s acceptance of practice by medical students was classified into binary variables. Participants who answered “Either way is okay,” “I want to be seen by a medical student if possible,” and “I would love to be seen by a medical student” were considered to be accepting of practice by medical students, whereas those who answered “I absolutely do not want to be seen by a medical student” or “I do not want to be seen by a medical student if possible” were considered to be nonaccepting. Participants’ satisfaction with practice of medical students was classified into three categories. Responses of “Satisfied” and “Slightly satisfied” were considered to indicate satisfaction, whereas responses of “Dissatisfied” and “Slightly dissatisfied” were considered to indicate dissatisfaction; a response of “Neither satisfied nor dissatisfied” was considered to indicate neither satisfaction nor dissatisfaction. The length of time that a supervising senior staff member was present was classified into two categories. Responses of “Sporadically” and “Not present or present for less than half of the time” were unified as “Less than half,” whereas responses of “About half of the time,” “Present more than half to nearly the entire time,” and “Present the entire time” were unified as “Half or over half.” All responses except for age were coded as either binary or categorical variables (see Appendix A). The details of both accepting and nonaccepting participants were analyzed by dividing them into two groups based on the experience of practice by medical students (experienced group and inexperienced group). Impressions of practice by medical students among participants in the experienced group were classified as accepting and nonaccepting. We also analyzed participants’ demands regarding medical education that would need to be met by participants to accept practice by medical students. Next, we analyzed the relationship between supervision by senior staff members and participants’ opinions for accepting or refusing practice by medical students. We also analyzed satisfaction with and attitudes toward practice by medical students according to the length of time that a supervising senior staff member was present. We assessed the difference with chi-square or Fisher’s exact tests. Statistical analyses were performed using JMP statistical software (version 8.0, SAS Institute Inc., Cary, NC). Observations with missing data were eliminated from the analyses, and p values less than .05 were considered statistically significant.
PUBLIC ATTITUDES TOWARD MEDICAL STUDENTS’ PRACTICE
RESULTS
Downloaded by [Nipissing University] at 05:48 17 October 2014
Demographics A total of 1,109 (46%) participants completed the questionnaire. The gender ratio and mean age were consistent with the 2005 Japanese census (Table 1). A total of 11% (117/1109) of participants had experienced practice by medical students. Fifty-nine (5%) of them experienced the practice of medical students for their own care (direct experiences), and the rest of them (5%) did for their family members (indirect experiences). Participants’ responses indicated that medical students predominantly performed interviews and physical examinations, and the major ailments or situations involved hospitalization and ambulatory care. Attitudes Toward Practice by Medical Students Overall, 26% (286/1,109) of participants accepted practice by medical students. Experienced participants were significantly more likely to accept practice by medical students than inexperienced participants (53/117; 45% vs. 232/969; 24%, p < .001). Among experienced participants, the rates of accepting of practice by medical students were similar between those with direct and indirect experiences (30/59; 51% vs. 23/58; 40%, p = .22). Table 2 shows the reasons given by participants for accepting or not accepting medical practice by medical students for both experienced and inexperienced groups stratified by acceptance. Fifty-one percent of the accepting participants thought that medical students should have more experience, and 31% thought that further development of medical science was needed. Among participants who were accepting of practice by medical students, experienced participants felt that medical students were more “polite” (17%) and “kind” (23%) than did inexperienced participants. Participants who were nonaccepting of practice by medical students reported the following reasons for refusal: “I feel anxious” (60%), “Medical students lack skills” (48%), “Medical students are unreliable” (46%), and “Medical students lack knowledge” (46%). Feelings of participants who had experienced and nonaccepting practice by medical students were closer to those of participants who were inexperienced and nonaccepting than those of participants who were experienced and accepting. Among the nonaccepting participants, 28% of those in the experienced group significantly felt that being seen by a medical student would take extra time, and 37% of those in the inexperienced group were nonaccepting because medical students do not have licenses to practice. Table 3 shows the impressions of practice by medical students in the experienced group (n = 117). Accepting participants gave the following impressions regarding their encounters with medical students significantly more frequently than nonaccepting participants: “kind” (53%), “polite” (51%), “hardworking” (49%), and “thorough” (30%). Although there was a significant difference in the number of accepting and nonaccepting participants who responded that medical students were
337
TABLE 1 Participants’ characteristics Characteristics Gender Male Age, Years (M = 48 years, SD = 17.2) 15–39 40–59 60–79 Working Status Worker (Including Part-Time) Full-Time Homemaker Student Unemployed Unanswered Education Level Elementary, Junior High School High School Professional Training College, Junior College University or Graduate School Unanswered Participants With Experience of Practice by Medical Students Participants Themselvesa Participants’ Family Memberb Situation of Practice Ambulatory Emergency Room Hospitalization Home Visit Contents of Practice of Medical Students Interview and Physical Examination Drawing Blood Noninvasive Examination (e.g., Electrocardiogram) Injection or Drip Infusion Explanation of Disease State
n (%) 557 (50) 376 (34) 399 (36) 334 (30) 663 (60) 170 (15) 81 (7) 182 (16) 13 (1) 152 (14) 476 (43) 220 (20) 245 (22) 16 (1) 117 (11) 59 (5) 58 (5) 44 (38) 3 (3) 69 (59) 1 (1) 67 (57) 15 (13) 21 (18) 24 (21) 33 (28)
Note. n = 1,109. a Experience of patients themselves includes experience of both themselves and their family (n = 9). b Experience of family members includes spouse, parent, grandparent, sibling, child, and grandchild.
“hard-working,” 31% of nonaccepting participants also reported that the medical students were working very hard. In contrast, nonaccepting participants reported the following impressions regarding practice by medical students significantly more frequently than accepting participants: “unreliable” (47%), “not smooth” (39%), “anxious” (38%), and “he/she did not introduce him/herself as a medical student” (31%).
338
K. MURATA, M. SAKUMA, S. SEKI, T. MORIMOTO
TABLE 2 Reasons for accepting or not accepting practice by medical students
Downloaded by [Nipissing University] at 05:48 17 October 2014
Reason Accepting participants Medical students do not have a medical license I worry whether senior doctors examine me properly Medical students lack knowledge Medical students lack skills I am scared of medical errors It takes extra time Medical students are unreliable I feel anxious My disease is serious My disease is mild Further development of medical science is needed Medical students should have more experience My medical expenses are reduced or exempted Medical students are polite Medical students are kind I am examined thoroughly I receive thorough explanations Examinations are supervised by senior doctors I have never been examined by a medical student Nonaccepting participants Medical students do not have a medical license I worry whether senior doctors examine me properly Medical students lack knowledge Medical students lack skills I am scared of medical errors It takes extra time Medical students are unreliable I feel anxious My disease is serious My disease is mild Further development of medical science is needed Medical students should have more experience My medical expenses are reduced or exempted Medical students are polite Medical students are kind I am examined thoroughly I receive thorough explanations Examinations are supervised by senior doctors I have never been examined by a medical student
Overall (n,%)
Experienceda (n,%)
Inexperienced (n,%)
p
12 (4) 17 (6) 21 (7) 18 (6) 12 (4) 3 (1) 15 (5) 23 (8) 7 (2) 19 (7) 88 (31) 146 (51) 2 (1) 18 (6) 26 (9) 30 (10) 21 (7) 40 (14) 84 (29)
5 (9) 5 (9) 7 (13) 5 (9) 6 (11) 1 (2) 4 (8) 6 (11) 3 (6) 5 (9) 21 (40) 32 (60) 0 9 (17) 12 (23) 8 (15) 2 (4) 11 (21) 0
7 (3) 12 (5) 14 (6) 13 (6) 6 (3) 2 (1) 11 (5) 17 (7) 4 (2) 14 (6) 67 (29) 114 (49) 2 (1) 9 (4) 14 (6) 22 (9) 19 (8) 29 (13) 84 (36)
.052 .33 .08 .34 .01 .46 .49 .40 .12 .36 .13 .14 1.0 .002
Teaching and Learning in Medicine: An International Journal Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/htlm20
Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan a
b
c
b
Kyoko Murata , Mio Sakuma , Susumu Seki & Takeshi Morimoto a
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan b
Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
c
Community Health Care, Hyogo College of Medicine, Nishinomiya, Japan Published online: 15 Oct 2014.
To cite this article: Kyoko Murata, Mio Sakuma, Susumu Seki & Takeshi Morimoto (2014) Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan, Teaching and Learning in Medicine: An International Journal, 26:4, 335-343, DOI: 10.1080/10401334.2014.945030 To link to this article: http://dx.doi.org/10.1080/10401334.2014.945030
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Teaching and Learning in Medicine, 26(4), 335–343 C 2014, Taylor & Francis Group, LLC Copyright ISSN: 1040-1334 print / 1532-8015 online DOI: 10.1080/10401334.2014.945030
Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan Kyoko Murata Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Mio Sakuma Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Susumu Seki Community Health Care, Hyogo College of Medicine, Nishinomiya, Japan
Downloaded by [Nipissing University] at 05:48 17 October 2014
Takeshi Morimoto Division of General Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Background: It is essential for medical students to interact directly with patients. However, patients may be reluctant to be seen by medical students in settings in which they may also be seen by senior staff. Purposes: To understand patients’ attitudes toward practice by medical students and consider the factors involved in obtaining patients’ cooperation, we conducted a nationwide crosssectional survey. Methods: We randomly selected 2,400 adult participants from all over Japan. Trained research assistants inquired about participants’ experiences and attitudes toward practice by medical students using a questionnaire. We compared differences in attitudes between participants who were accepting of practice by medical students and those who were not, as well as differences between participants who had experienced practice by a medical student versus those who had not. Results: A total of 1,109 (46%) participants were included in the study. Eleven percent (117/1109) of the participants had experienced practice by a medical student. One fourth of participants were accepting of practice by medical students, and experienced participants were significantly more likely to be accepting of practice by medical students than inexperienced participants (45% vs. 24%, p < .001). Impressions of practice by medical students among accepting participants with previous experiences included “polite,” “kind,” and “hard-working.” Fiftynine percent (637/1088) of participants indicated that they would request a senior staff member’s supervision when being seen by a medical student. Conclusions: The present nationwide survey suggests that education emphasizing bedside manner may be effective in promoting patients’ cooperation of medical students. In addition, providing information to patients about medical students and
We thank Ms. Makiko Ohtorii, Ms. Ai Mizutani, and Ms. Mika Sakai for their assistance with administration and data management. Correspondence may be sent to Takeshi Morimoto, Division of General Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan. E-mail: morimoto@ hyo-med.ac.jp
efforts to increase supervision during clinical clerkship should be emphasized to foster the public’s cooperation. Keywords
attitudes, clinical clerkship, medical students, general public, survey
BACKGROUND Interacting directly with patients is an integral aspect of clinical clerkship for medical students; however, patients may be reluctant to be seen by medical students in settings in which they have an equal opportunity to be examined by senior staff. Medical students thus face a considerable challenge in establishing good relationships with patients, as well as in effectively acquiring necessary skills through clinical clerkship. Real patients are a vital part of clinical training, as they bridge the gap between textbook learning and real-world medical practice.1 Traditionally, patients have played a relatively passive role, simply acting as teaching “materials,”2 and in the past patients remained largely unaware of the involvement of medical students in their care.3 More recently, however, the importance of obtaining the patient’s consent before the patient can be seen by a medical student increased. The complex matters of medical students’ right to clinical education and patients’ right to decline care from medical students may therefore come into conflict.1 Patients’ attitudes toward practice by medical students have yielded variable results in medical settings. One previous study found that patients were reluctant to be seen by medical students in the emergency department.4 Other studies have demonstrated that patients’ comfort levels with the involvement of medical students in their care appeared to differ based on several factors, including the sex of the medical student, the level of
335
336
K. MURATA, M. SAKUMA, S. SEKI, T. MORIMOTO
Downloaded by [Nipissing University] at 05:48 17 October 2014
involvement, and the student’s stage of training,5 and that patients’ cooperation was dependent on medical students’ competencies.6 In addition, the hospital or medical school where the student received his or her clinical training was also shown to be a significant factor.1 Medical students must be able to establish good relationships with patients in order to gain their support. This in turn gives medical students opportunities to practice their clinical skills in a real-world setting. In the present study, a nationwide survey was carried out in Japan in order to investigate attitudes toward practice by medical students and experiences of receiving care from medical students among the general public and to identify key factors that may foster public cooperation with clinical clerkships.
METHODS Participants and Setting A nationwide survey was conducted using a representative sample of 2,400 people (15–79 years old) selected from among the entire population (128 million residents) of Japan (M age = 43 years; 49% men [2005 population census]). Two hundred research assistants went door to door to conduct surveys with participants in March 2006.7 The participants were selected by multistage, stratified random sampling. Municipalities were selected at the first stage and specific areas were selected from each municipality at the second stage. Then participants were selected at equal intervals using a basic resident register. The research assistant visited each participant twice. At the initial visit, they asked participants to complete the paper questionnaire. They visited again to collect the questionnaire several days later. The demographics of participants were also obtained in the questionnaire. If the assistants could not contact the participants at the second visit, they were considered as refusing to participate. This study was approved by Kyoto University Graduate School and Faculty of Medicine Ethics Committee and informed consent was obtained from each participant. Questionnaire A questionnaire was developed to measure the general population’s attitudes toward clinical practice by medical students. Key questions addressed the experiences, impressions, and requirements associated with practice by medical students. Most questions had multiple-choice responses (see Appendix A). Eight nonmedically trained persons reviewed the questionnaire prior to the survey to improve its clarity and brevity. Measurements and Statistical Analyses Participants’ characteristics and data regarding the following experiences and attitudes toward practice by medical students were obtained: (a) experience of practice by a medical student, (b) acceptance of practice by medical students and its reasons for acceptance, and (c) demands regarding medical education
that must be met before the participant would accept practice by medical students. For participants with the experience of being seen by a medical student, we asked the following additional questions: (a) the situation and contents of the practice, (b) satisfaction level with the practice, and (c) length of time that a supervising senior staff member was present (see Appendix A). Participants with experience of practice by a medical student were defined as a participant or participant’s family member who had ever seen by a medical student. A participant’s spouse, parent, grandparent, sibling, child, or grandchild was included as a family member. Those who answered “No/I am not sure” were defined as inexperienced. Participant’s acceptance of practice by medical students was classified into binary variables. Participants who answered “Either way is okay,” “I want to be seen by a medical student if possible,” and “I would love to be seen by a medical student” were considered to be accepting of practice by medical students, whereas those who answered “I absolutely do not want to be seen by a medical student” or “I do not want to be seen by a medical student if possible” were considered to be nonaccepting. Participants’ satisfaction with practice of medical students was classified into three categories. Responses of “Satisfied” and “Slightly satisfied” were considered to indicate satisfaction, whereas responses of “Dissatisfied” and “Slightly dissatisfied” were considered to indicate dissatisfaction; a response of “Neither satisfied nor dissatisfied” was considered to indicate neither satisfaction nor dissatisfaction. The length of time that a supervising senior staff member was present was classified into two categories. Responses of “Sporadically” and “Not present or present for less than half of the time” were unified as “Less than half,” whereas responses of “About half of the time,” “Present more than half to nearly the entire time,” and “Present the entire time” were unified as “Half or over half.” All responses except for age were coded as either binary or categorical variables (see Appendix A). The details of both accepting and nonaccepting participants were analyzed by dividing them into two groups based on the experience of practice by medical students (experienced group and inexperienced group). Impressions of practice by medical students among participants in the experienced group were classified as accepting and nonaccepting. We also analyzed participants’ demands regarding medical education that would need to be met by participants to accept practice by medical students. Next, we analyzed the relationship between supervision by senior staff members and participants’ opinions for accepting or refusing practice by medical students. We also analyzed satisfaction with and attitudes toward practice by medical students according to the length of time that a supervising senior staff member was present. We assessed the difference with chi-square or Fisher’s exact tests. Statistical analyses were performed using JMP statistical software (version 8.0, SAS Institute Inc., Cary, NC). Observations with missing data were eliminated from the analyses, and p values less than .05 were considered statistically significant.
PUBLIC ATTITUDES TOWARD MEDICAL STUDENTS’ PRACTICE
RESULTS
Downloaded by [Nipissing University] at 05:48 17 October 2014
Demographics A total of 1,109 (46%) participants completed the questionnaire. The gender ratio and mean age were consistent with the 2005 Japanese census (Table 1). A total of 11% (117/1109) of participants had experienced practice by medical students. Fifty-nine (5%) of them experienced the practice of medical students for their own care (direct experiences), and the rest of them (5%) did for their family members (indirect experiences). Participants’ responses indicated that medical students predominantly performed interviews and physical examinations, and the major ailments or situations involved hospitalization and ambulatory care. Attitudes Toward Practice by Medical Students Overall, 26% (286/1,109) of participants accepted practice by medical students. Experienced participants were significantly more likely to accept practice by medical students than inexperienced participants (53/117; 45% vs. 232/969; 24%, p < .001). Among experienced participants, the rates of accepting of practice by medical students were similar between those with direct and indirect experiences (30/59; 51% vs. 23/58; 40%, p = .22). Table 2 shows the reasons given by participants for accepting or not accepting medical practice by medical students for both experienced and inexperienced groups stratified by acceptance. Fifty-one percent of the accepting participants thought that medical students should have more experience, and 31% thought that further development of medical science was needed. Among participants who were accepting of practice by medical students, experienced participants felt that medical students were more “polite” (17%) and “kind” (23%) than did inexperienced participants. Participants who were nonaccepting of practice by medical students reported the following reasons for refusal: “I feel anxious” (60%), “Medical students lack skills” (48%), “Medical students are unreliable” (46%), and “Medical students lack knowledge” (46%). Feelings of participants who had experienced and nonaccepting practice by medical students were closer to those of participants who were inexperienced and nonaccepting than those of participants who were experienced and accepting. Among the nonaccepting participants, 28% of those in the experienced group significantly felt that being seen by a medical student would take extra time, and 37% of those in the inexperienced group were nonaccepting because medical students do not have licenses to practice. Table 3 shows the impressions of practice by medical students in the experienced group (n = 117). Accepting participants gave the following impressions regarding their encounters with medical students significantly more frequently than nonaccepting participants: “kind” (53%), “polite” (51%), “hardworking” (49%), and “thorough” (30%). Although there was a significant difference in the number of accepting and nonaccepting participants who responded that medical students were
337
TABLE 1 Participants’ characteristics Characteristics Gender Male Age, Years (M = 48 years, SD = 17.2) 15–39 40–59 60–79 Working Status Worker (Including Part-Time) Full-Time Homemaker Student Unemployed Unanswered Education Level Elementary, Junior High School High School Professional Training College, Junior College University or Graduate School Unanswered Participants With Experience of Practice by Medical Students Participants Themselvesa Participants’ Family Memberb Situation of Practice Ambulatory Emergency Room Hospitalization Home Visit Contents of Practice of Medical Students Interview and Physical Examination Drawing Blood Noninvasive Examination (e.g., Electrocardiogram) Injection or Drip Infusion Explanation of Disease State
n (%) 557 (50) 376 (34) 399 (36) 334 (30) 663 (60) 170 (15) 81 (7) 182 (16) 13 (1) 152 (14) 476 (43) 220 (20) 245 (22) 16 (1) 117 (11) 59 (5) 58 (5) 44 (38) 3 (3) 69 (59) 1 (1) 67 (57) 15 (13) 21 (18) 24 (21) 33 (28)
Note. n = 1,109. a Experience of patients themselves includes experience of both themselves and their family (n = 9). b Experience of family members includes spouse, parent, grandparent, sibling, child, and grandchild.
“hard-working,” 31% of nonaccepting participants also reported that the medical students were working very hard. In contrast, nonaccepting participants reported the following impressions regarding practice by medical students significantly more frequently than accepting participants: “unreliable” (47%), “not smooth” (39%), “anxious” (38%), and “he/she did not introduce him/herself as a medical student” (31%).
338
K. MURATA, M. SAKUMA, S. SEKI, T. MORIMOTO
TABLE 2 Reasons for accepting or not accepting practice by medical students
Downloaded by [Nipissing University] at 05:48 17 October 2014
Reason Accepting participants Medical students do not have a medical license I worry whether senior doctors examine me properly Medical students lack knowledge Medical students lack skills I am scared of medical errors It takes extra time Medical students are unreliable I feel anxious My disease is serious My disease is mild Further development of medical science is needed Medical students should have more experience My medical expenses are reduced or exempted Medical students are polite Medical students are kind I am examined thoroughly I receive thorough explanations Examinations are supervised by senior doctors I have never been examined by a medical student Nonaccepting participants Medical students do not have a medical license I worry whether senior doctors examine me properly Medical students lack knowledge Medical students lack skills I am scared of medical errors It takes extra time Medical students are unreliable I feel anxious My disease is serious My disease is mild Further development of medical science is needed Medical students should have more experience My medical expenses are reduced or exempted Medical students are polite Medical students are kind I am examined thoroughly I receive thorough explanations Examinations are supervised by senior doctors I have never been examined by a medical student
Overall (n,%)
Experienceda (n,%)
Inexperienced (n,%)
p
12 (4) 17 (6) 21 (7) 18 (6) 12 (4) 3 (1) 15 (5) 23 (8) 7 (2) 19 (7) 88 (31) 146 (51) 2 (1) 18 (6) 26 (9) 30 (10) 21 (7) 40 (14) 84 (29)
5 (9) 5 (9) 7 (13) 5 (9) 6 (11) 1 (2) 4 (8) 6 (11) 3 (6) 5 (9) 21 (40) 32 (60) 0 9 (17) 12 (23) 8 (15) 2 (4) 11 (21) 0
7 (3) 12 (5) 14 (6) 13 (6) 6 (3) 2 (1) 11 (5) 17 (7) 4 (2) 14 (6) 67 (29) 114 (49) 2 (1) 9 (4) 14 (6) 22 (9) 19 (8) 29 (13) 84 (36)
.052 .33 .08 .34 .01 .46 .49 .40 .12 .36 .13 .14 1.0 .002
