AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. January 2005, Volume 7, Number 1.

Module 4

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Case 4.1: Balancing Patient Care and Student Education—Mr. Harvey's Central Line

Additional Information

Perhaps the most valuable feature of medical education is the practical experience provided by supervised participation in clinical encounters. Medical students gain experience by performing basic procedures and observing clinical interactions. Patient care may also be enhanced by the involvement of medical students: medical students provide patients an additional opportunity both to discuss problems and to receive information because students have more time to spend with patients (eg, when taking a medical history). As Opinion 8.087, "Medical Student Involvement in Patient Care" makes clear, patients should be apprised of planned medical student involvement because some patients may prefer that students not be involved in their care:

Opinion 8.087, "Medical Student Involvement in Patient Care"

Patients and the public benefit from the integrated care that is provided by health care teams that include medical students. Patients should be informed of the identity and training status of individuals involved in their care and all health care professionals share the responsibility for properly identifying themselves. . . Patients are free to choose from whom they receive treatment. When medical students are involved in the care of patients, health care professionals should relate the benefits of medical student participation to patients and should ensure that they are willing to permit such participation. Generally, attending physicians are best suited to fulfill this responsibility. . . in instances where a patient may not have the capacity to make decisions, student involvement should be discussed with the surrogate decision-maker involved in the care of the patient whenever possible.

Medical students may be able to gain more experiences sooner if patients are left unaware of their training status or planned involvement. Avoiding disclosure, however, implies that the primary mission of the teaching hospital is medical training and ignores a patient's right to choose whether to participate in student education. It is inappropriate to assume that a patient is implicitly willing to participate in the training of medical students or other health professionals merely by being admitted to an academic medical center. When they introduce themselves as students and verify that patients agree to student participation in their care, medical students engage in a simple form of truth-telling that constitutes a first step in establishing and reinforcing trust in the patient-physician relationship.

In those cases when patient consent is unattainable (eg, emergency care), the participation of medical students should be evaluated judiciously and employed cautiously.

Related topic: Medical students as "patients"

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