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Gold, incentives and meh

We don't mind a student sitting in on consultations - but will the patients mind?

Dr John Holden offers advice to a practice that is happy for a pre-medical school student to sit in on consultations but wants the arrangement to run smoothly and is keen not to cause offence to patients.

Dr John Holden offers advice to a practice that is happy for a pre-medical school student to sit in on consultations but wants the arrangement to run smoothly and is keen not to cause offence to patients.

Q A pupil from a local college has just passed his A levels and earned a place at medical school. He wants to come into the surgery once a week over the summer and sit in on consultations. In principle, we are happy to oblige. But how do we ensure this arrangement goes smoothly?

A Teenagers vary widely in their levels of maturity and responsibility, so you need to be happy that he is mature enough to behave appropriately and recognises the need for confidentiality.

Before making any decision, it's worth considering inviting the student to the surgery so you can find out more about him.

If you decide to go ahead, you should make it very clear to him what would be expected.

He should also be required to sign a confidentiality agreement before beginning work.

Such an agreement might explain that the student will be sitting in on selected consultations for educational purposes and that he understands and undertakes to ensure that any information must remain strictly confidential.

The MDU has received a number of inquiries like these over the years.

Our advice is that it may be best not to offer work experience to anyone living within or near their practice area simply because of the likelihood of encountering someone known to them.

Make things clear to patients
If your practice accepts work experience students you need to make this clear to patients.

You could do this by placing a notice in the waiting room, explaining why you think it may be a valuable learning experience for the student and stressing that the student would only be invited to sit in on a consultation with the patient's consent.

The GMC, while not referring to prospective medical students, states that doctors must give patients the information they want or need about their right to refuse to take part in teaching or research. (paragraph 9, Consent: patients and doctors making decisions together, 2008)

Whenever a third party is present in a consultation, it is important for the patient to be told exactly who that person is and given ample opportunity to object.

Individual patients attending the GP should have the situation explained and be asked for their consent when making their appointment.

For this reason the MDU recommends that students' attendance be confined to pre-booked clinics, as this allows patients ample time to decide whether to agree to the student's presence.

Receptionists should always explain to patients the identity and status of anybody sitting in on a consultation, as would the doctor on the patient's arrival in the consultation room.

The word "student" used to describe a person not yet at university could be misleading to some patients.

It should be made clear that in this case the student has just passed his A levels and has won a place at medical school.

GPs need to consider whether some patients may feel awkward about saying that they don't wish to have a work experience student present.

Patients should be told they can withdraw their consent at any stage, even during the consultation, and that if they refuse permission for the student to be present this will not in any way affect the care they are given.

You may decide to exclude third parties from consultations with certain types of patient – for example people of a similar age to the student, or anybody that might be nervous about voicing an objection or be reluctant to discuss their case in full.

If a student is present during the consultation, it is important to record the fact in the clinical records.

Also note the name and status of the student.

Dr John Holden is a medicolegal adviser with the MDU

© The MDU 2008

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