Objective: Medical students experience a higher rate of patient refusal to participate in OB/GYN clinic visits in comparison to other medical specialties during their training. Medical students are a vital member of the team whose participation in patient care functions to improve the patient experience and further medical student education in this field. Patients may feel more inclined to have medical students participate in their visits, provided they have an opportunity to learn more about them prior to meeting them in the exam room. At our institution, reusable cards with the medical student’s photo and other facts about them were presented to patients during the rooming process. The effect of these cards was measured by a patient satisfaction survey, and rates of medical student refusal pre and post intervention
Methods: First, pre-card surveys for patient and students were composed. These surveys evaluated refusal rates for students to participate in Ob/Gyn outpatient encounters and perceptions of student interactions. Patient surveys were distributed with after-visit summaries and completed prior to leaving clinic. Student surveys were distributed electronically and completed at the end of the rotation. Students also complete patient encounter tracking sheets during the outpatient clinic portion of their Ob/Gyn rotation to assess refusal rates.
Second, formatting and content of biography cards were determined. The latter dictated the former, so it was decided to put the medical student\'s name, photo, pronouns, three facts (students selected from different prompts on surveys) and a standardized thank you on the biography cards. Given this we decided to use a half sheet of paper (front and back). These cards were laminated, and each student received 5 cards to use during their outpatient clinic portion of their Ob/Gyn rotation.
Third, implementation of the cards involved placing cards in rooms prior to the start of clinic. Medical assistants (MAs) would present the cards to the patient as they were being roomed. MAs would then ask if patient wanted to have a medical student participate in their care. Once patient was done with their encounter, card was wiped down during the room turnover phase and left in the room for the next patient.
Fourth, post card surveys for patients and students were distributed in the same manner as pre-card surveys. These surveys evaluated the same factors while also evaluating perception of the cards by students and patients.
Results: Given our lack in number of medical students who participated in our overall project, we were unable to determine any significant findings within our survey results. With that said, we were able to obtain some interesting qualitative data. Majority of patients liked having the cards and 46.3% reported an increase willingness to allow students to participate in their medical care. However, a majority of students did not find the cards to be an effective tool to build rapport nor improve number of patient interactions. This is shown by the refusal rates for involvement in outpatient encounters that we collected from the patients. Prior to card implementation there was a 10.2% refusal rate versus 11% refusal rate after card implementation. However, this may be a little misguiding as nearly 25% of the students who filled out post card surveys, reported not using their cards at all.
Additionally, when looking at refusal rates broken up by gender, we found that males were refused at significantly higher rates. In our pre-card data, male students were nearly four times as likely to be rejected as their female counter parts. In the post card data, male students were nearly twice as likely to be rejected as their female counter parts. Thus, maybe the cards were more effective at reducing male participation boundaries when it came to outpatient Ob/Gyn encounters.
Conclusion/ Discussion: Our work from this project highlights the need to continue to work on ways to improve medical student participation within our outpatient Ob/Gyn clinics. This is demonstrated by our 10-11% refusal rate for students to participate in outpatient encounters. With that said, our project has also taken great strides in tackling this problem by designing and implementing biography cards for medical students to use in outpatient encounters. While our results do not strongly suggest effectiveness by improving refusal rates, there is a large caveat to that. Nearly 25% of students did not use the cards at all, which makes it difficult to draw adequate conclusions from our work. However, we did learn that patients who were exposed to the cards liked having the cards. Additionally, nearly half of these patients reported increased willingness to allow a medical student to participate in their care. At the very least, this suggest these cards are making it more likely patients will agree to have a medical student participate in their care.
Things in which we could have done better was improve our awareness and education of card implementation to clinic staff. Utilizing a dedicated liaison for each clinic site to attend meetings consistently would have helped facilitate card implementation. Furthermore, we could have systematically informed clinical professors of our project so they in turn could help encourage students to use their cards more often. This may have made the largest impact given several of the clinical professors were excited to hear about our results once they learned of the project. Lastly, we could have incentivized our MAs/students more to improve card usage and distribution of surveys. Given our lack of resources we found that this would be difficult to do at this point in time.
Overall, the cards had promising impacts on patients. With better adherence to usage of the cards by students and a larger study population, we may even see an impact on refusal rates. At the very least though, this may be one tool to help improve medical student involvement within our outpatient Ob/Gyn clinics.
Topics: Faculty Development Seminar, 2022, Student, Clerkship Director, Patient Care, Systems-Based Practice & Improvement,
