Table 6.
Studies reporting the impact of FM clerkships on teaching FPs and their patients
| TEACHING FPs | |||||
|---|---|---|---|---|---|
| Authors (year) | Country | Clerkship features | Study methods | Key findings | Strength grade |
| Grant and Robling (2006)84 | UK | Y final; ? setting and duration; O | Action research; participation and interviews with all staff of a FP practice preparing to have final year students for FP clerkship (3 FPs); 5 months before and 1 year after having a student | All members of team enjoyed having students and experienced enhanced sense of professional identity and strengthened team ethics | 4 |
| Heath and Beatty (1998)79 | USA | Y 3; 4 weeks; O | Coding and billing forms of 4 teaching FPs at 2 sites; 10 half day sessions during April and July (varied experience of student) (438 patients) matched with 10 half days same months (431 patients) without student | No significant differences in entering billing codes, performing office procedures or ordering diagnostic tests; mean nr patients 12.0 with/12.3 without student | 3 |
| Kearl and Mainous (1993)80 | USA | Y 3; ? weeks; O; urban | 4264 patient encounter forms (43% with a student) at clinic of FM department; 9 FPs and 3 FM residents (over 4 months: days with/without students); paired-sample design | No significant differences in mean number of patients/half day (productivity: 6.3 with and 6.1 without, p=0.7) and average billed charges (p=0.62) between days with/without student | 4 |
| Kollisch et al (1997)81 | USA | Y 3; 4 weeks; O; mixed setting | Phone interviews with preceptors from 42 teaching practices (RR 35/38) | 55% commented on the time issue when student present (slowed down practice/had to stay longer); benefits and concerns reported | 4 |
| Levy et al (1997)82 | USA | Y 3; 2–3 weeks; O; urban | Postal questionnaire to all preceptors (RR 130/139) | Mean of 51±30 min/day increase in working time when student present; overall positive comments about teaching students; 87% had to stay longer; 31% saw less patients; 25% lost income; list of benefits and challenges provided; 58% complain of more time; positives: 40% positive interaction with student | 4 |
| Ricer et al (1997)83 | USA | Y 3; 4 weeks; O; mixed setting | Observations of 26 preceptor-student pairs; one research assistant timing teaching activities during visit and nr of patients of preceptor with (316)/without (131) student and comparing to non-teaching partner at same days; 19 full days and 7 half days July-August (first months of clerkship; little previous exposure of students so ‘max’ teaching time needed) | Estimate of 1.23 h in addition to usual day without students (teaching cost calculated at US$60); for 10 preceptors with partners no significant difference in number of patients (171 preceptor vs 164 non-preceptor partner) | 2 |
| Sturman et al (2011)85 | Australia | Y 3; 8 weeks; O; urban | Face-face interviews; quota sampling to represent diversity of teaching clinics/FPs (RR 28/29 teaching clinics; 60/61 FPs) | 83% comment on time issue (longer working day 30–60 min or >60 min); 52% quote ‘intellectual stimulation’ as benefit; rewards and challenges reported | 4 |
| Vinson and Paden (1994)46 | USA | Y 3/4; 3 weeks; O; mixed setting | Postal questionnaires to private preceptors who had taught during previous academic year (RR 46/56) | 40/46 reported increase of working time when with student (mean 46±32 min/day; median 45; range 30–120 min); 1% reported decrease in billing charges; 25/46 report ‘learning from students’ as a benefit; 17/46 report ‘time’ issue as a problem | 3 |
| Vinson et al (1996)62 | USA | Y 3; 4 weeks; O; urban | 10 328 observations: 55% from (RR 22/29) private teaching FPs; researcher directly observed 1 day with and without student; recording start and end of work and nr patient encounters; 12 academic FPs for two half-days with/without student; time and motion study; researcher observed and recorded activity (list of 35) in random selected times during the day/half-day; inter-rater reliability between observers >0.70 | Private FPs: mean increase of time when student present 52 min (95% CI 16 to 88) p.0.007; no significant change in nr patients/day, but significant change in productivity (nr patients/h): decrease of 0.6/h (95% CI −1.1 to −0.1) p=0.03; academic FPs spent 6 min less/day when student present (95% CI −67 to 55 min), but not stat significant; no change in nr pts/day and productivity; analysis of pt, admin or teaching activities: no major differences except academic FPs allow students to be semi-independent, while private FPs more passive/observing role | 4 |
| Sprenger et al (2010)30 | Austria | Y 6; 5 weeks; O | Self-administered questionnaires immediately after clerkship (RR 114/146); Likert scale to assess satisfaction with clerkship | 100% agreed teaching students was positive; 91% reported there was not enough time for tutorials | 4 |
| Pichlhofer et al (2013)29 | Austria | Y ?; ? weeks; O; urban | Online questionnaire survey (RR 59/74) | ∼92% feel always/frequently positively motivated by student’s presence; 51%: student’s presence caused need for more time always/frequently; ∼90%: teaching facilitates reflecting on daily work always/frequently | 4 |
| McKee et al (1998)28 | USA | Y 3; 6 weeks; O; urban | Daily activity logs and quality scores during the clerkship (RR 21/60; 105 sessions without and 98 with student) | No decrease in clinical productivity (number of patients/h: 2.74 vs 2.81 p=0.58) and overt-time hours (34 vs 41 min p=0.27); clinical productivity correlated to nr of patients seen independently by the student | 3 |
| Patients | |||||
| Bentham et al (1999)86 | UK | Y 6; 5 weeks; O; mixed setting | Questionnaires after consultations at 6 FP teaching practices (RR 130/148 patients) | 62%: no negative impact on the quality of consultation when student present; 98% would not refuse a student; 35% report advantages and 2% negative effect when student present; 2%: consultation longer when student present | 4 |
| Haffling and Hakansson (2008)91 | Sweden | Y final; 16 days; O; mixed setting | Questionnaires after consultation, handed out by 3 cohorts of students (RR 429 patients; 150/222 students reported) | 92%: no negative impact on quality of consultation when student present; 64% would not refuse a student; 1%: dissatisfied by student’s presence (longer consultation; difficult to talk about personal problems; other reasons); 22%: thought they could contribute to teaching students | 4 |
| Monnickendam et al (2001)90 | Israel | Y 6; 3 weeks; O | Questionnaire after consultation handed out by students at 46 teaching practice (RR 375/375? patients) | Majority: no negative impact on quality of consultation when student present; 77% would not refuse a student; 25% report advantages and 4% did not report a positive effect of student’s presence on the physical examination and medical interview | 4 |
| O’Flynn et al (1999)87 | UK | Y 4; unclear duration and setting | FP posted questionnaires to 25 patients the day after consultation with student present (RR 335/480) | 38.8%: learned more about their problem due to FP teaching the student; 33.3%: more time to talk when student present; 8.4%: left without saying what they wanted; 32%: less space to talk about personal problems; 34% would prefer to see physician alone | 3 |
| Price et al (2008)88 | UK | Y 5; 4 weeks; O | Questionnaire to consecutive patients after consultation with and without student; handed out by FP who also recorded length of consultation (RR 35/60 FPs; 1351 consultations with and 1119 without student) | Patients in consultations with vs without student present: validated scores for enablement 4.3 (3.9) vs 4.6 (3.9) p=0.06 and empathy 42.7 (8.0) vs 43.7 (7.2) p<0.01 (but no practical relevance); consultation length: 10.9±6 min with and 9.4±4.8 without student (p<0.01); 21% who had consented to a student present would have preferred to see physician alone; 72% learned more about their problem due to the FP teaching the student and 59% had more time to talk about their problem | 4 |
| Prislin et al (2001)31 | USA | Y 3; 1 day/week; O | Questionnaires after consultation handed out by FPs for 3 consecutive consultations with student (RR FP practices of 45/87 students; 121 patients) | 80%: no negative impact on the quality of consultation when student present; 76% report advantages and 6% negative effect of student’s presence; 10–12% consultation took longer when student present; 67% did not decrease time with doctor | 3 |
| Salisbury et al (2004)89 | Australia | Y 3; 2 weeks; O; urban | Questionnaires handed out by researcher before and after consultation with student. FP and student blinded (RR 8/30 FPs; 88/94 patients who consented/104 available) | 71% would not refuse a student; for any aspect (Hx taking, PE, procedure) student observing doctor: 93.2% expected, 88.6% occurring, 86.3% would accept in future; doctor observing student 77.2% expected, 69.55% occurring; 84% accepted; student alone for some part 42% expected, 20.4% occurring, 59% accepted | 3 |
| Pichlhofer et al (2013)29 | Austria | Y ?; ? weeks; O; urban | Questionnaires either pre or post consultation with student present (RR 28/74 FPs; 508 patients before and 346 after consultation questionnaires) | 95% (pre)−97% (post) report presence of student did not interfere with patient-doctor relationship; 75% did not report consultation took longer when student present; 5–13% who had consented to a student present would have preferred to see physician alone | 4 |
?, No data available in the paper; FM, family medicine/general practice; FP, family/general practitioner; Hx, history; nr, number; O, obligatory; Y, year.