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We have Liftoff! Rocketing towards Medical Student Success in OB/GYN Clinics!
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.
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.
Faculty Development Seminar, 2022, Student, Clerkship Director, Patient Care, Systems-Based Practice & Improvement,