Abstract
ObjectiveMedical students in China are currently facing a dilemma of whether to clarify their identity as students to patients. Further investigation is needed to support policy-making. The aim was to identify factors influencing medical students’ decision on whether or not to clarify their identity to patients and to examine the effects of their decision.MethodsThe study was a cross-sectional nationwide multicenter survey consisting of 947 medical students. A self-designed questionnaire was composed of 19 structured questions investigating the present situation and participants’ perception of the ethical dilemma surrounding medical student identity. The questionnaires were distributed randomly in teaching hospitals affiliated with 13 medical schools across China from June 2015 to January 2016.ResultsA total of 947 valid questionnaires were retrieved with a valid response rate of 83.7%. Most medical students (71.4%) tended to be ambiguous about their student identity in front of patients. The frequency of encountering distrust and patients’ or patient relatives’ refusal to allow students to perform procedures was significantly lower for students who explicitly stated their identity than for those who were ambiguous about their identity (p<0.001). Less experience in clinical rotations (<0.5 y/0.5–1 y, OR 2.7, 95% CI 1.7–4.3; <0.5 y/>1 y, OR 3.6, 95% CI 2.0–6.5), preceptors’ straightforward introduction of the students (OR 8.7, 95% CI 5.4–13.8) and students’ acknowledgment of patients’ right to know (OR 2.3, 95% CI 1.2–4.5) were related to students’ clear self-introduction to patients.ConclusionIt is beneficial for medical students to clearly explain their identity to patients in order to decrease patient distrust and prevent the refusal to have certain appropriate procedures performed. Several methods, including emphasizing the role of mentors, developing curriculum for medical students, and creating clear regulations and guidelines for revealing the identity of medical students on the healthcare team can help address and ideally resolve this ethical dilemma of identity disclosure.
Highlights
Clinical clerkship, a stage when learners in medicine move from the classroom to the workplace of practicing physicians [1], is an essential component in the education of a future physician
Patients’ autonomy and choice of health care providers should be respected and Chinese patients are becoming more aware of their right to give informed consent about medical student involvement in their care
Honesty and respect for patients’ autonomy are basic requirements in medical ethics, and disclosure of student status is a direct reflection of these norms [17]
Summary
A stage when learners in medicine move from the classroom to the workplace of practicing physicians [1], is an essential component in the education of a future physician. Through exposure to daily patient management during clerkship, students gain essential hands-on experience in a practical clinical setting. Medical students are supposed to actively interact with patients and be directly involved in patient care. Because medical students are not qualified to practice as doctors themselves, informing patients that medical students are involved in their medical care may make patients anxious [2] and increase the probability of refusal. Patients’ autonomy and choice of health care providers should be respected and Chinese patients are becoming more aware of their right to give informed consent about medical student involvement in their care. When patients discover later that student involvement was concealed, they may feel deceived and may lose trust in doctors, which is detrimental because this trust is the core of doctor-patient relationships [2]
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