Medical student/student doctor access to patients in an emergency department

OBJECTIVES: To determine the proportion of patients in a teaching hospital ED who are available to medical students; identify barriers to student access to patients; and determine whether patients are more likely to be accessible if the term student doctor is used rather than medical student. METHODS: Repeated cross-sectional study of the ED of a tertiary teaching hospital. Interviews were attempted with all patients in the ED during six 4 h periods. Outcome measures included: number of patients present and accessible to students; present but inaccessible, absent or unfit to be seen for clinical reasons; number of patients consenting to history, physical examination and certain procedures; and difference in patient consent between the terms 'medical student' and 'student doctor'. RESULTS: Overall, 180 of 450 (40.0%) patients completed the interview, 72 (16.0%) were able to be observed only, and 198 (44.0%) were not suitable for interview or observation. The common reasons for patient unsuitability were: physically not available (60%), being assessed by a health professional or undergoing a procedure (13.0%) altered mental status (7.4%), unstable or terminally ill (5.2%); refusal to participate in the study (4.8%), or dangerous or under arrest (4.1%). No significant differences were found in patient willingness to undergo clinical skills from 'student doctors' compared with 'medical students'. CONCLUSION: A minimum 40% of patients in a tertiary ED are accessible for student learning, with high proportions of patients accepting of students practising supervised history-taking, physical examination, and most less-invasive procedural skills.