TEACHING MEDICAL STUDENTS IN GENERAL PRACTICE THE PATIENTS VIEW

1. TEACHING MEDICAL STUDENTS IN GENERAL PRACTICETHE PATIENTS VIEW Asist. Nena Kopčavar Guček Outpatient Clinic Zdravje Smoletova 18 1000 Ljubljana

2. 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 Kopčavar Guček

3. 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 Asist. Nena Kopčavar Guček

4. 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. Asist. Nena Kopčavar Guček

5. 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! Asist. Nena Kopčavar Guček

6. 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 Asist. Nena Kopčavar Guček

7. 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 Asist. Nena Kopčavar Guček

8. If conducted properly with • expertise, • care, • respect, teaching in general practice may benefit all the three participants: • the patient, • the student and • the teacher. Asist. Nena Kopčavar Guček

9. 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. Asist. Nena Kopčavar Guček

10. The CORNERSTONES of a successful consultation in GP including a student present: • respect, • candor, • empathy, • verbal and • nonverbal communication. Asist. Nena Kopčavar Guček

11. Reminders for the STUDENT-PATIENT COMMUNICATION during the consultation: • include the patient actively • importance of active listening, • patient should give feed-back on the studentś 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 Asist. Nena Kopčavar Guček

12. 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 Asist. Nena Kopčavar Guček

13. Results (1)Upons seeing the student in the GP`s office, the pts were: • not surprised in 52% • pleasanlty surprised in 22% • non-pleasantly surprised in 2% • disturbed in 4% Asist. Nena Kopčavar Guček

14. 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% Asist. Nena Kopčavar Guček

15. Results ( 3 )The presence of the student in the GP`s 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 Asist. Nena Kopčavar Guček

16. 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% Asist. Nena Kopčavar Guček

17. 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% Asist. Nena Kopčavar Guček

18. Conclusions:Teaching 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. Asist. Nena Kopčavar Guček

19. 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. Asist. Nena Kopčavar Guček

20. »…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 Asist. Nena Kopčavar Guček

21. Thank youfor your attention Asist. Nena Kopčaver Guček