Derriford Hospital, University Hospitals Plymouth, Plymouth, PL6 8DH, UK.
Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK.
BMC Med Educ. 2023 Mar 4;23(1):149. doi: 10.1186/s12909-023-04066-x.
Limited research indicated patients were largely amenable to seeing medical students pre-pandemic. However, the COVID-19 pandemic has highlighted the potential risk of nosocomial transmission and harm to patients from students. Patient opinions regarding these risks remain unexplored, which impacts elicitation of informed consent. We aim to identify these, and explore whether reflection on the risks and benefits of direct student interaction influenced patients' attitudes. For guidance, we further explored measures to reduce perceived infection risk.
We designed an original questionnaire for a cross-sectional study, completed by 200 inpatients from 25 wards between 18/02 and 16/03/2022 at Derriford Hospital, Plymouth. Patients in intensive care, with active COVID-19 infection or unable to comprehend the study information were excluded. The responses of a guardian were recorded for inpatients under 16. 17 questions were included - the initial question, reporting willingness to talk with and be examined by students, was repeated following nine questions exploring risks and benefits of student interaction. A further four questions addressed reducing the perceived infection risk. Data is summarised using frequencies and percentages, and with Wilcoxon signed-rank and rank-sum tests of association.
85.4% (169/198) of participants gave an initial positive response to seeing medical students, and despite a third of participants changing their response 87.9% (174/197) remained willing after the survey resulting in no significant change. Furthermore, 87.2% (41/47) of those who perceived themselves at severe risk of harm from COVID-19 remained happy to see students. Participants reported reassurance knowing students were: fully vaccinated (76.0%); wearing masks (71.5%); lateral flow test negative within the last week (68.0%) and wearing gloves and gown (63.5%).
This study demonstrated the willingness of patients to engage in medical education despite recognised risks. Patient reflection on the risks and benefits of student interaction did not significantly reduce numbers willing to see students. Even those perceiving a risk of serious harm remained happy to have direct student contact - a demonstration of altruism in medical education. This suggests informed consent should include discussion of infection control measures, risks and benefits to patients and students, and offer alternatives to direct inpatient contact.
有限的研究表明，患者在大流行前大多愿意接受医学生的治疗。然而，COVID-19 大流行凸显了学生可能给患者带来医院内传播和伤害的潜在风险。患者对这些风险的看法仍未得到探索，这影响了知情同意书的签署。我们旨在确定这些风险，并探讨对直接学生互动的风险和益处的思考是否会影响患者的态度。为此，我们进一步探讨了降低感知感染风险的措施。
我们设计了一个原始的问卷进行横断面研究，2022 年 2 月 18 日至 3 月 16 日期间，在普利茅斯德里弗医院的 25 个病房中，对 200 名住院患者进行了问卷调查。不包括重症监护病房的患者、有活动性 COVID-19 感染的患者或无法理解研究信息的患者。对于 16 岁以下的住院患者，记录了监护人的回答。问卷包括 17 个问题——第一个问题是报告是否愿意与学生交谈和接受学生检查，在提出 9 个关于学生互动的风险和益处的问题后，再次报告了这一问题。另外 4 个问题涉及降低感知感染风险。数据使用频率和百分比进行总结，并使用 Wilcoxon 符号秩和检验和秩和检验进行关联分析。
85.4%（169/198）的参与者最初对与医学生交谈和接受学生检查表示积极回应，尽管三分之一的参与者改变了他们的回答，但在调查后仍有 87.9%（174/197）愿意，这并没有导致显著变化。此外，87.2%（41/47）认为自己有严重感染 COVID-19 风险的患者仍然愿意让学生看诊。参与者表示，他们对学生的以下情况感到放心：完全接种疫苗（76.0%）；佩戴口罩（71.5%）；过去一周内快速抗原检测结果为阴性（68.0%）；以及戴手套和长袍（63.5%）。
这项研究表明，尽管存在风险，患者仍愿意参与医学教育。患者对学生互动的风险和益处的思考并没有显著减少愿意与学生见面的人数。即使那些认为自己有严重伤害风险的人仍然愿意与学生直接接触——这表明在医学教育中存在利他主义。这表明知情同意书应包括感染控制措施、对患者和学生的风险和益处的讨论，并提供替代直接与住院患者接触的方法。
