Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
PLoS One. 2018 Jul 11;13(7):e0200335. doi: 10.1371/journal.pone.0200335. eCollection 2018.
Medical 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.
The 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.
A 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.
It 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.
中国医学生目前面临着是否向患者表明学生身份的困境。需要进一步的调查来为决策提供支持。本研究旨在确定影响医学生是否向患者表明身份的因素，并探讨其决策的影响。
本研究是一项全国性的横断面多中心调查，共纳入 947 名医学生。采用自行设计的问卷，调查医学生身份相关伦理困境的现状和参与者的认知。问卷于 2015 年 6 月至 2016 年 1 月期间在全国 13 所医学院校附属医院的教学医院中随机发放。
共回收有效问卷 947 份，有效回收率为 83.7%。大多数医学生（71.4%）在面对患者时对自己的学生身份持模棱两可的态度。与身份不明的学生相比，明确表明身份的学生遭遇不信任和患者或患者家属拒绝让学生进行操作的频率明显较低（p<0.001）。临床轮训经验较少（<0.5 年/0.5-1 年，OR 2.7，95%CI 1.7-4.3；<0.5 年/>1 年，OR 3.6，95%CI 2.0-6.5）、带教老师直接介绍学生（OR 8.7，95%CI 5.4-13.8）和学生承认患者的知情权（OR 2.3，95%CI 1.2-4.5）与学生向患者明确自我介绍有关。
医学生向患者明确表明身份有利于减少患者的不信任，防止拒绝进行某些适当的操作。强调导师的作用、为医学生制定课程、制定明确的规定和准则以揭示医疗团队中医学生的身份等方法可以帮助解决和理想地解决这一身份披露的伦理困境。
