Is three a crowd? Impact of the presence of a medical student in the general practice consultation

OBJECTIVES To determine the impact of the presence of a medical student on the satisfaction and process of the general practice consultation from the perspective of the general practitioner (GP), patient and student. METHODS An observational study was conducted in regional general practices accepting third-year medical students. General practitioners, patients and medical students were asked to complete a questionnaire after each consultation. The main outcome measures were: patient satisfaction; GPs' perceived ability to deliver care; medical students' satisfaction with their learning experience; length of consultation; and patient waiting times. RESULTS Of the 26 GP practices approached, 11 participated in the study (42.3%). Patients returned 477 questionnaires: 252 consultations with and 225 without a student present. Thirteen GPs completed 473 questionnaires: 248 consultations with and 225 without a student. Twelve students attended 255 consultations. Most patients (83.5%) were comfortable with the presence of a student. There were no significant differences between consultations with and without a student regarding the time the patients spent in the waiting room (p=0.6), the patients' perspectives of how the GPs dealt with their presenting problems (100% versus 99.2%; p=0.6) and overall satisfaction with the consultation (99.2% versus 99.1%; p=0.5). Despite these reassuring findings, a significantly higher proportion of patients in consultations without students raised sensitive or personal issues (26.3% versus 12.6%; p<0.001). There were no statistically significant differences in the lengths of consultations with and without students (81% versus 77% for 6-20minutes consultation; p=0.1) or in the GPs' perceptions of how they effectively managed the presenting problem (95.1% versus 96.0%; p=0.4). Students found that the majority (83.9%) of the 255 consultations were satisfactory for learning. CONCLUSIONS The presence of a medical student during the GP consultation was satisfactory for all participant groups. These findings support the ongoing and increased placement of medical students in regional general practice. Medical educators and GPs must recognise that patients may not raise personal issues with a student present.