Relationships between students and patients differ according to individual variables. Patients' evaluations of students are influenced by factors such as patients’ age, gender, level of education, and ward in which they are located.
With regard to appearance, which concerned patients' views on the appropriate appearance of students during clinical classes, an examination was conducted to assess patients' views of the importance of various features.
A Polish study found that 96.8% of medical workers wore clean and buttoned-up clothing while on duty. It also revealed that a healthcare worker's neat appearance inspires greater trust in patients, which is a vital aspect of the doctor‒patient relationship.29 It can be inferred that the same is likely to be true for medical students.
In accordance with our survey, a significant proportion (82.13%) of patients paid attention to the neatness of students' clothes during classes, consistent with a study by Rehman et al.,30 in which 82% of patients believed physician attire to be important.
Among the age groups evaluated, the oldest group of patients (aged 71–92) was the most attentive to the neatness of students’ clothing during clinical classes. The importance of professional attire for physicians tends to increase with the age of the patient.31–35
According to A. Mehrabian, nonverbal communication accounts for 55% of the sender's message. Collins36 indicated that in culture the culture of the studied population, placing hands in pockets can signal either a desire to dominate or a lack of courage and may be perceived negatively by recipients. Medical students might tend to talk to their patients while keeping their hands in their pockets.37
Our study found that nearly half of the patients in this study were uncomfortable when students did so. Patients with higher levels of education were more likely to be disturbed by this behavior than those with basic vocational education.
Many studies in different countries have revealed that medical students have significantly higher levels of stress than the general population.38–40 Studies have revealed that more than 80% of medical residents report that stress negatively affects the care they provide to their patients.41 It is reasonable to assume that stress influences medical students in a comparable manner. In the study by Haffling and Hakansson,20 patients described negative experiences with medical students expressing a feeling of insecurity, as the patient thought the student had too much responsibility. In our study, the responses varied significantly. A total of 34.99% of responders thought that students looked stressed during clinical classes, and 35.48% thought the opposite.
Studies suggest that the presence of tattoos or expressive makeup on a doctor's body may be perceived differently in different countries. In Pennsylvania, USA, a study found that tattoos did not significantly impact the patient's perception of the doctor.42 However, in Italy, the entire sample considered it inappropriate for a doctor to have visible tattoos or heavy makeup.43 In Brazil, patients also had negative views about doctors with heavy makeup.44 Polish research showed that a significant portion of patients viewed tattoos negatively, with 49% believing that doctors should cover their tattoos and 29.7% advocating for a categorical ban on doctors showing tattoos.45
Our study found that 28.04% of patients thought students should not wear expressive makeup, 28.29% had no opinion, and 43.67% did not mind. Older patients were significantly more opposed to excessive makeup than younger patients.
More than half of the patients surveyed did not believe medical students should cover their tattoos during classes, while over 20% preferred they do. Older patients had a higher preference for tattoo coverage, in line with the common trend of older individuals having more negative views toward tattoos than younger individuals.46
In regards to propriety, our study examined patients' perceptions of appropriate standards of behavior for students during clinical classes.
Studies have found that over half of patients want physicians to introduce themselves using their first and last names, with more females than males expressing this preference.47–49 Another study found that 76% of patients preferred physicians to introduce themselves with their full name and academic degree.50 We wanted to determine whether this preference applied to medical students, as there was not enough literature on this topic.
Almost half of the patients believed medical students should introduce themselves with their first and last name when entering the room. Patients in the 18–35 age group had no strong opinion on this matter, while patients in the 71–92 age group preferred the use of full names. Additionally, a large majority of patients (85.86%) considered it important for students to greet them upon entering the room.
A Chinese study found that mobile phone addiction is prevalent among medical students and negatively influences their academic achievement, concentration and performance.51 According to a Polish study, 92% of surveyed nursing students used a smartphone at least once per hour.52 Medical staff talking on the phone and a phone ringing were cited as the causes of annoying noise for patients during hospitalization.53 In our study, almost one in four patients felt that students overused their phones during clinical classes.
According to Kapp's analysis on the involvement of medical students in patient care, “misleading patients about the educational status of their health care providers is fraught with potential pitfalls”.54 Medical students may not disclose their inexperience to avoid being excluded from a patient's care, especially during invasive procedures.55 Multiple studies have recommended informing patients when a medical student is involved in their care, particularly during procedures.56–58 Over 80% of patients in our study felt that medical students should always identify themselves as such, with younger patients placing less importance on this.
Studies have demonstrated that using complex medical language can hinder communication between doctors and patients, highlighting the importance of clear and understandable language in clinical settings.24,25 Our survey showed that nearly a quarter of patients believed medical students used incomprehensible jargon during clinical classes. Age played a significant role, with younger patients being less concerned about colloquial language, while over a quarter of the oldest group felt that students used too much informal language.
The clinician who teaches the class in a hospital setting is essential to the education of healthcare professionals. A strong clinician-student relationship is crucial for the student's development and success. In a Polish survey, 82% of teachers felt disrespected.59
Our study revealed that half of respondents evaluated students based on their approach toward their clinician, but limited research exists on this topic. Older patients and those with vocational education place more importance on the student’s approach to the teacher. Maintaining a professional and respectful attitude toward teachers is crucial for an effective educational process.
The empathy and altruism variable explored patients' perceptions of the ability of medical students to understand and respond to their feelings, as well as the altruistic desires of patients to contribute to the education of future healthcare professionals.
Medical students' nonverbal communication is correlated with empathy, while verbal communication is not, according to previous studies.60
Patients perceive healthcare providers to be more approachable when they smile, as shown by previous research.47,61
Our study showed that patients considered it important for medical students to smile during interactions, suggesting that smiling may be valued by patients as a nonverbal sign of empathy and concern in medical settings.
Patients often face loneliness, but medical students can show empathy by talking with them. Social interaction is important in combating loneliness, as studies have shown,62–64 particularly among elderly individuals who spend extended periods of time in the hospital.65
Our study found that approximately 50% of patients found talking to medical students helpful for loneliness, with older patients benefiting more. This finding suggests that age may affect the effectiveness of verbal communication in addressing loneliness in medical settings.
Regardless of gender, department, age, or education level, 75% of respondents in our survey emphasized the importance of medical students remembering previous conversations. It is essential for students to view patients as the object of treatment, not just the subject of their disease,66–68 as patients are more receptive to students who show interest in them as individuals than just in their medical condition.67,69
Over half of the patients surveyed were unhappy with students solely focusing on their illness, indicating a need for more consideration of patient preferences and autonomy in medical education.
Research has shown that patients may view their participation in the education of healthcare professionals as a meaningful and fulfilling experience, even while managing their own illness.64,70,71
In our study, 83% of patients felt important in the education of future doctors, with stronger sentiment expressed by patients over 65. Forty percent of patients desired more frequent student volunteering for examinations during classes, with gender, ward, and age influencing patient preferences for hands-on learning. Males and urology ward patients were more willing to participate than those in the gynecology ward, while patients aged 18–29 were more willing than older patients. Consideration of these factors is necessary for comprehensive education for future healthcare professionals.
Our study examined how medical students respected patients' privacy during clinical classes. It is essential for medical students, similar to licensed physicians, to uphold ethical and legal standards to protect patient confidentiality.72
Patients were uncomfortable with medical students observing intimate medical procedures but not nonintimate procedures, according to the present study. Additionally, a patient in a previous study asked for a student to leave during a personal consultation, feeling judged and objectified in the presence of an unsympathetic doctor.16 Studies have shown that patients are less likely to allow medical students to be present during consultations for emotional or intimate problems. Patients prefer being asked for consent well in advance and not in the presence of students.73,74
This study found that half of the patients felt positively about discussing emotional problems with a student, but young females were more hesitant than older females. While 59% of patients would allow a student to perform an internal exam, females and younger individuals were more hesitant.20,75
Patients have been found to be keen to emphasize the importance of students being closely supervised by nurses or doctors to ensure the safety of patient care.76,77
This study also found that one-third of patients did not want students to examine them without a tutor present, and 7% declined even with a physician present. Twenty percent did not consent to students viewing their medical history without a tutor, while 60% agreed with supervision.78
Our study showed that a significant proportion of patients expressed discomfort and concerns regarding their privacy and comfort during intimate examinations with medical student involvement. Over 20% of patients felt that their privacy was not prioritized enough, and over 25% felt uncomfortable when left alone with students. Almost half of the patients reported discomfort during intimate examinations involving students, with women being more uncomfortable than men. Coleman and Murray's study found that patients did not assume that consenting to see students also granted them access to their medical records.64
Our study found that nearly 20% of patients had concerns about medical confidentiality breaches by medical students.
Our study investigated patients' opinions on the organization of clinical classes with medical student involvement.
Many patients in London (18%) and Newcastle (9%) reported not being asked for their consent to have a medical student present during their visit, with many feeling they had no choice in the matter. Many patients preferred to be informed in advance about it.79
Another study indicated that the majority of patients did not consider obtaining prior consent to be an important issue in relation to teaching. Only 15% insisted on prior consent.80
In Santen et al.’s55 study, over half of the patients were unaware that they could be a medical student's first patient for a procedure, while 66% believed that they should be informed if a student was performing their first procedure on them.
A study found that some medical students' concerns about obtaining written consent for an exam were dismissed by senior clinicians, leading to personal distress and ethical dilemmas.81
In our study, over 75% of patients valued being asked for consent before participating in clinical classes with students, with 81.39% wanting students to always ask for permission before examining them.
A study by Cooke et al.82 found that only 3% of patients had a negative view of the presence of students in clinical settings.
According to our study, 11.66% of all patients believed that they participated in classes with students too often.
Female patients prefer same-gender students, as found in studies by Haffling and Håkansson20 and O'Flynnet al.83 Opposite-gender students make a significant number of women and men uncomfortable with sensitive issues, according to Bentham et al.84 Patients in the obstetrics and gynecology and genitourinary departments were less willing to have students involved, as reported by Sayed-Hassan et al.19 In Krueger's85 study, 83% of women chose a female provider when shown a picture of female and male obstetrician-gynecologists.
Simons et al.79 found that 24% of patients preferred a student of the same gender to conduct their physical examination, while Choudhury et al.78 reported that for 21.5% of patients, their willingness to have a student present during their conversation with their doctor was influenced by the gender of the student.
Our study found that 58.81% of patients felt comfortable with a female student examining them. Female patients and older patients were more likely to prefer that a female student examine them. Patients in the gynecology ward were less comfortable with male students than patients in other departments. Younger patients were less comfortable with male examinations than older patients.
The study aimed to collect patient views on how students should behave and appear during clinical classes to improve their education and enhance patient comfort.
The study found that patients, especially older patients, value neatness in clothing and expect formal introductions from students using their full name.
Patients have varying opinions on visible tattoos and the use of expressive makeup by medical students during clinical classes. However, they express discomfort when students keep their hands in their pockets during conversation, which could be perceived negatively. Older patients are generally more opposed to visible tattoos and expressive makeup than younger patients.
Medical students should be aware of patients' preferences for their appearance and behavior to establish positive patient interactions and build trust.
Patients prefer medical students to use clear language and inform them of their role and training level. Furthermore, older and vocationally educated patients are more critical of students' approach to their supervising physician than younger and more highly educated patients.
The study examined patients' perceptions of medical students' empathy, focusing on nonverbal and verbal communication and altruistic attitudes. The results indicate that smiling and engaging in conversation are important for expressing empathy and concern to patients. Elderly patients reported greater benefits of conversation in reducing loneliness. Patients want to be treated as individuals and not just in terms of their disease, and they want their preferences and autonomy to be respected during medical education.
Furthermore, patients find it satisfying to participate in the education of healthcare professionals. Older patients feel more strongly about contributing to the education of medical students than younger patients.
The study indicates that patients feel uncomfortable when left alone with medical students, particularly during examinations of intimate areas. Discomfort is more prominent among women and those with higher education. This highlights the importance of prioritizing patients' privacy and comfort during medical education.
Patients express fear of confidentiality breaches by medical students. Closer supervision of medical students and patient consent before intimate consultations may improve patients' experiences during medical encounters. Gynecology patients have particular concerns about confidentiality breaches.
Patients want doctors to ask for their consent before clinical classes and students to always ask for permission before examining them. Patients also want to be informed in advance if a student might be present during their medical visit.
Patients also have varying preferences regarding the gender of the student examining them. Female patients tend to prefer a student of the same gender, especially for sensitive issues. Only a small proportion of patients believe that they participate in classes with students too often.
Patient engagement in the process of training aspiring medical practitioners is indisputably crucial for the optimal development of medical professionals. The study determined that, akin to other research works conducted elsewhere, patients in this teaching hospital exhibit a positive inclination toward participating in classes with students. Nonetheless, some patients experience discomfort during such classes. By implementing minor alterations in the organization of clinical classes, such as focusing on nonverbal communication or student attitudes, smiling, and having students introduce themselves, patient comfort during classes can be easily enhanced.
It is essential to give significant consideration to the variation in perceptions of students among patients across different departments and among patients of varying ages. For instance, in gynecological wards, privacy and intimacy are particularly vital due to the sensitive nature of the patient's problems, and among elderly patients, respectful and courteous student behavior or presentable appearance hold greater significance.
It is recommended that more extensive research be conducted to accurately describe and define the most critical factors that contribute to patient comfort during classes, particularly in countries, where studies on this subject are mostly limited.