Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Title: Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Short Title: Medical student teaching in a private hospital. Authors: Farnaz Sanaei, Margaret Schnitzler, Kirsty Foster & Mark Arnold. Institution: North Shore Hospital St Leonards, Sydney NSW, AUSTRALIA and the Northern Clinical School, University of Sydney, NSW, AUSTRALIA Corresponding Author: Associate Professor Mark H Arnold, Northern Clinical School, Level 7 Kolling Building Royal North Shore Hospital St Leonards, Sydney NSW AUSTRALIA. A/Prof Arnold’s contact details: Tel: 61 029 419 5258. FAX: 61 029 413 3458. EMAIL: [email protected] Author Details: Farnaz Sanaei RM, B Sc M Sc PhD, Project Manager North Shore Private Hospital and Northern Clinical School University of Sydney, Sydney NSW AUSTRALIA. Margaret Schnitzler MB BS (Hons) FRACS PhD, Academic Coordinator (Surgery) North Shore Private Hospital, Associate Professor (Surgery) Northern Clinical School, Staff Specialist, Royal North Shore Hospital, and Visiting Medical Officer, North Shore Private Hospital, St Leonards, Sydney NSW AUSTRALIA.. Kirsty Foster BSc MB ChB MRCGP DRCOG MEd (ALGC) PhD, Senior Lecturer in Medical Education & Sub Dean Education, Sub Dean International, Northern Clinical School, University of Sydney, Sydney NSW AUSTRALIA.. Mark H Arnold MB BS FRACP MBeth, Academic Coordinator (Medicine) North Shore Private Hospital, Associate Professor (Medicine) Northern Clinical School University of Sydney, VMO Rheumatologist, Royal North Shore Hospital and Visiting Medical Officer North Shore Private Hospital, St Leonards, Sydney NSW AUSTRALIA. 1 | Page Sanaei F, Schnitzler M, Foster K and Arnold M MedEd Publish www.mededworld.org Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Abstract Title: Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Authors: Farnaz Sanaei, Margaret Schnitzler, Kirsty Foster & Mark H. Arnold Objectives: To assess the acceptability and feasibility of introducing medical students into clinical placements in a private hospital. Design, setting and participants: North Shore Private Hospital is co-located with Royal North Shore Hospital and Northern Clinical School. Following the introduction of medical student clinical placements, focus groups and detailed interviews were conducted with 32 medical students, 28 patients, 30 Visiting Medical Officers and allied health staff. In addition, a semi-structured questionnaire was administered to 158 patients. Written student evaluation of each placement was also reviewed. Data were analysed using descriptive statistics and thematic analysis. Main outcome measures: We assessed whether student teaching was practically achievable in this setting and acceptable to all participants. The views and attitudes of participants toward medical students in a private hospital were also explored. Results: There was a high degree of acceptability amongst all groups of participants. 94% of patients were willing to be interviewed and examined by medical students. Some major themes identified were the favorable environment, enhanced access to clinical settings and experiences, overall advantages for all participants and potential challenges. Conclusions: Medical student teaching in a large private hospital can offer accessible and suitable clinical training opportunities. The concept of private hospital inpatients participating in student education is acceptable to patients, students, teachers and allied health staff. Perceived barriers to the participation of private patients in student teaching did not materialize from the perspective of any of these groups. 2 | Page Sanaei F, Schnitzler M, Foster K and Arnold M MedEd Publish www.mededworld.org Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Introduction Medical students numbers have increased significantly from 2007 to 2012 (Medical Deans of Australia and New Zealand, 2012). The Australian and New Zealand Medical Deans’ 2008 National Clinical Training Review suggested that changes in the established manner of teaching would be required to meet this demand (Medical Deans of Australia and New Zealand, 2008). The majority of elective surgery in Australia is now performed in private hospitals, as is much obstetric care (Dent MM et al., 2010, Brown L and Barnett JR, 2004) and other procedural work (Brown L and Barnett JR, 2004). More often, patients with chronic diseases are managed in non-hospital ambulatory settings, and these two trends potentially limit students’ exposure to the very conditions which they will deal with in their working lives (Dent MM et al., 2010). Prior to the expansion in medical student numbers, local research indicated that as many as 49-60% of patients in public hospitals may be practically unavailable to participate in student teaching (Olson LG et al., 2005, Calenza A et al., 2011), necessitating “ alternatives to teaching hospitals for acquiring clinical skills”, and likewise Crotty opined that we “urgently need to expand clinical teaching into the private sector”(Crotty BJ, 2005). Armstrong’s observation that “patients on the private teaching services are as sick and present the same general range of illness as do the public teaching ward patients” (Armstrong SH, 1952) holds true for case-mix comparisons between Australian private and public hospitals (Nichol B, 2007). In Australia, there are several co-located public teaching and private hospitals (Brown L and Barnett JR, 2004) which offer an opportunity to expand teaching capacity (Brooks PM et al., 2003), though in the Australian setting (Crawford D, 2010), this mode of student teaching has only recently been specifically evaluated (Tiong MK et al., 2013) The establishment of NSPH as a teaching hospital of the University of Sydney (UoS) allowed us the opportunity to study a collaborative approach to the clinical education of medical students in a private hospital collocated with a UoS teaching hospital, and well established clinical school. Methods: Setting North Shore Private Hospital (NSPH) is a 241 bed hospital co-located with a 628 bed teaching hospital Royal North Shore Hospital (RNSH). Graduate students at the Sydney Medical Program (SMP) from stages 1-3 (years 1-4) received part of their clinical training at NSPH. In 2010 funding was received from the Department of Health and Ageing to increase clinical training capacity and NSPH was utilised to provide additional clinical placements. An ethnographic approach was used to capture the views of inpatients, stage 3 students spending a one month clinical attachment and staff at NSPH. Ethical approval was obtained from the UoS Human Research Ethics Committee and Northern Sydney Central Coast Human Research Ethics Committee. Data collection and analysis 3 | Page Sanaei F, Schnitzler M, Foster K and Arnold M MedEd Publish www.mededworld.org Medical student teaching in a private hospital: A positive experience for patients, students, and staff. Data collection involved in-depth one-on-one and (focus group interviews) with all involved (n= 28 inpatients, 30 staff and 32 students). In addition, a patient questionnaire was developed using the literature and piloted with patients, Visiting Medical Officers (VMOs) and University faculty staff before final administration to all patients (n=158). Interviews were transcribed and analysed thematically. Descriptive analysis was performed on data generated from the questionnaires. Results: More than 90% of inpatients were willing to be involved in medical student history taking, physical examination and the observation of procedures. Only eight of the 158 patients to whom the questionnaire was administered expressed that they did not want to be involved. Questionnaire results are presented in Table 1: “Patient responses to questions about involvement in medical student teaching”. Four main themes were identified via descriptive analysis: 1. Enhanced access to clinical settings and experiences The private setting provided students with opportunities that may not always be available in the public attachment. a. Interaction with VMOs VMOs and students expressed the view that teacher-student interactions were more individualised in the private setting, in the office and operating theatre. “But I think here (Private) they certainly benefit from one to one time with a VMO that often you don’t get at all in the public hospital” (VMO33) b. Less competition for patient access The small number of students and the lack of junior medical staff at NSPH contributed to the favourable clinical experience. In the operating theatre, students had more opportunity to assist during surgery. “I think really the lack of other students is the main advantage here because you don’t go into a patient and you never get the excuse that they’ve already seen fifty thousand other students..”(S28 Y3). “So basically there are a lot of students... and it’s not just students but also interns, registrars. Everyone is in different stages of their training, so you are all vying for teaching opportunities and teaching time with clinicians” (S2Y3). 4 | Page Sanaei F, Schnitzler M, Foster K and Arnold M MedEd Publish www.mededworld.org Medical student teaching in a private hospital: A positive experience for patients, students, and staff. c.