Hospice patients accepting of student examinations

The majority of hospice inpatients are happy to be examined by medical students, indicate the results of a UK study.

However, some do have concerns about being physically examined by students, including the worry that they will feel pain, or find it tiring or embarrassing.

The results are important "for doctors organising the student-patient interactions at the hospice, specifically regarding appropriate supervision of the physical examination," remark the researchers in BMJ Supportive and Palliative Care.

Indeed, some of the study participants felt that student supervision was vital during physical examination, to prevent them "prodding somewhere that hurt," said one patient respondent.

A total of 42 hospice patients took part in the study at a 12-bed center in Exeter, UK, between March and September 2011. The participants were aged between 30 and 90 years, 16 were men, and 39 had a diagnosis of cancer. Just five participants had already been seen by a medical student in some capacity while in the hospice.

Participants completed a questionnaire including such questions as: "Do you feel it is acceptable for medical students to physically examine patients in a hospice?"

The findings showed that just over three-quarters (76%) of patients believed this was very or mostly acceptable, while an overwhelming majority (95%) felt it was very or mostly acceptable for medical students to interview hospice patients. A similarly large proportion (88%) felt it was very or fairly important for medical students to have experience examining hospice patients.

While 81% of respondents reported that they would be very or fairly likely to agree to a medical student examining them, 17% said they would find it "fairly difficult" to decline. Moreover, 10% of respondents said they would feel obliged to consent to an examination, even if they did not want it.

"Clinicians must ensure that patients feel they are able to decline easily," writes author Jennifer Hayes, from Exeter Hospiscare in Devon, UK.

A total of eight patients were worried that physical examinations by students would be embarrassing, four were worried they might provoke pain, and four patients were concerned it would be too tiring for them. One participant said: "It depends how you feel - if I felt very unwell, I might still feel obliged to say 'yes.' "

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