Los estudiantes de medicina como parte del equipo de salud / Medical students as members of the health care team

Background: Teaching hospitals include both undergraduate and postgraduate students, but the role of medical students in the health care team has not been clearly established. Aim: To know the opinion of different professionals about the role of medical students and how this opinion may have an influence in medical education. Material and Methods: A qualitative method was used, asking open questions to focus groups of physicians, nurses and midwives, technicians and undergraduate medical students of 4th and 5th grade. Results: Physicians believe that medical students have no special role in the health care team, nurses think that they may help in commu-nication with patients, and technicians (nurses’s aids) value their companionship and closeness with patients. Medical students recognize that their main function is to learn but they are aware that they do help patients. They suggest increasing their integration with other students of other health related careers. Conclusions: Although medical students are usually not seen as part of the health care team, they may fulfll a role with patients during their clinical learning practice. This would improve the quality of their training and the multidisciplinary work of the health care team.

Acompañamiento del enfermo: Una experiencia de aprendizaje sobre el significado de la enfermedad / Accompanying a patient as an experience to learn the meaning of disease

Background: Due to technical advances and progressive specialization, patient physician relationship evolved from being based on confidence and comprehension to be impersonal and contractual. Aim: To evaluate the change produced in medical students' concept of the meaning of disease, after living an experience of accompanying a patient and their family environment. Material and methods: We used a qualitative research methodology based on participative-action to evaluate an educational method in which a group of third year medical students accompanied a previously selected chronic patient during two months. We performed two focal groups, one previous to the experience and the second one a month later. Additionally, every student wrote a personal narration of the experience. We compared the students' perception of the meaning of disease for the patients and their relatives, before and after the experience. Results: The students confirmed their previous conception about chronic disease, but they also discovered the ways in which some patients and their families overcome their ¡imitations. They pointed out their belief that the physician's comprehension of the meaning of disease for the patient and the family, a need to practice a good medicine and that this knowledge change the physician-patient relationship. Conclusions: This experience was an effective way of ¡earning the meaning of disease, which might be a part of medical student' training, with the corresponding adjustments and changes.

Relación estudiante de medicina-enfermo: visión de los estudiantes / Medical student - patient relationschip: the students' perspective

Background: The relationship between medical students and patients has special characteristics that require to be well understood to prepare both students and tutors. Aim: To learn about medical students' thoughts and experiences once they start working with patients, how do they solve difficulties or problems and their perceptions about professional roles and patient rights. Material and methods: Qualitative study based on semi-structured interviews applied to 30 volunteer third year medical students who were beginning their clinical practice. The answers to open questions were transcribed and then analized and grouped by topics and categories. Results: Helping others was the main motivation to go to medical school. Other reasons were scientific interest and social status. Students felt prepared to communicate with patients. However they felt anxious, stressful and fearful of not being competent or not being able to answer patients' questions. There were some differences between male and female students' feelings. Nevertheless students declared that they had rewarding experiences with patients. They all recognized that patients have the right to reject being treated by students. The answers also showed that the first clinical experiences led to significant changes in their views of the medical profession. Conclusions: Students are aware of their trainee condition, the benefits that they obtain being in contact with patients and of their limitations. Patients must voluntarily accept to be subject of the students' training program and informed consent procedures need to be developed.

Relación estudiante-enfermo: Visión del paciente / Student patient relationship from the patient's point of view

Background : Patients are becoming increasingly active in their relationship with medical professionals. Their relationship with medical students needing to learn clinical skills, may be specially problematic if patients are not willing to accept their involvement in the medical team. Aim: To examine patient's perceptions of their relation with medical students and their agreement to let students be part of the treating team. Material and Methods: Qualitative study using taped semi-structured interviews addressed to inpatients from one public and one private hospital in Chile. Results: Both groups of patients acknowledged that students dedicated more time to them, but they expressed their preference to limit student's participation to clinical history taking and physical examination. They also expected them to be observers rather than actors. Patients from the private hospital emphasized that only one student per instructor should participate in their care. Patients from the public hospital were more compliant about student's participation. The right to refuse students' involvement in their care was clearly known by all patients from the private system and by most patients from the public hospital. Conclusions: Patients in Chilean public and private hospitals were in general positive regarding student's participation in their care. Students' clinical practice ought to strictly respect patients's rights, and patients should be considered volunteers who generously agree to cooperate with the education of medical students.