Abstract
What problems were addressed? In medical education, the adequate supervision of medical students is known to result in improved patient outcomes. However, this presents a challenge in clinical clerkships, in which faculty supervisors need to balance their time and resources. As such, the ability to provide indirect supervision to students – particularly in a setting in which the faculty member is not directly managing the student–patient encounter – is an important skill. Although minimal supervision of students presents a feasible solution to challenges in faculty supervision, it is unclear how such practices are perceived by patients and how they affect the learning experiences of students. To investigate this issue, this study examined patient and medical student perceptions of clinical teaching in a setting with minimal faculty supervision. What was tried? We performed a cross-sectional study with a sequential sample of obstetrics patients at an antenatal out-patient clinic. Questionnaires focusing on perceptions of students’ performance during the consultation were administered preand post-student consultation. In addition, patients were asked to write three words representing what they felt before and after the consultation. Students’ selfperceptions of their performance while consulting with patients were obtained through a questionnaire administered at the end of the process. An openended question requested students to write five words representing what they felt after consulting with patients with minimal clinical supervision. What lessons were learned? Of the 95 pregnant women studied, 95% knew that the student would perform routine antenatal care and would receive feedback from the supervisor following the consultation. They acknowledged that it was important for students to perform prenatal care as part of their training (85%). Before the consultation, 22% were not sure if they felt comfortable being examined by a medical student and 20% were unsure whether they could trust a student. After the consultation, 97% of patients felt comfortable about the examination and 99% felt they trusted the students. Of the pre-consultation descriptor words, ‘anxiety’ was the most frequently used word. ‘Calm’ and ‘satisfaction’ were the most frequently used post-consultation descriptors. Of the 77 students, 56% were in Year 5 of medical school and 44% were in Year 6. Students agreed that the ambulatory format with minimal faculty supervision encouraged their participation and engagement (82%). They felt that case discussions with faculty staff were useful (90%) and contributed to their learning (88%). The words ‘trust’, ‘secure’, ‘responsibility’ and ‘autonomy’ were the most representative of those used by students to express their feelings about meeting patients by themselves, supported by the outside supervision of the preceptor. Students expressed interest in knowing the opinions of the pregnant women about their performance in providing supportive medical care (92%) and confirmed that they would feel comfortable about being assessed by patients (84%). We observed positive patient feedback, and the perceptions of finalyear students regarding this out-patient clinical teaching method with minimal faculty supervision reinforced the potential to expand their autonomy. These findings may support additional assessments that incorporate patient perspectives into the overall clinical evaluation of students, which may improve the validity of the clinical assessment system.
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