Patients’ Attitude towards Medical… Worku A 158

ORIGINAL ARTICLE

PATIENTS’ ATTITUDE TOWARDS MEDICAL STUDENTS

INVOLVEMENT IN THEIR HEALTH CARE AT TIKUR
ANBESSA SPECIALIZED HOSPITAL, ADDIS ABABA,
ETHIOPIA, 2010
Worku Animaw Temesgen

ABSTRACT

BACKGROUND: Patients' willingness to the involvement of medical students in their health care is
the mandatory input to medical education. Admitted patients’ willingness level should be known and
factors affecting willingness should be identified and it is necessary to act upon them for better medical
care.
METHODOLOGY: A cross-sectional hospital based survey was conducted to assess the admitted
patients’ attitude towards medical students’ involvement in their health care at Tikur Anbesa
Specialized Hospital in 2010. Data were collected from 422 adult patients admitted in Tikur Anbesa
Specialized Hospital from April to May 2010 using structured questionnaire and by interview method.
The data gathered in this way were then processed using SPSS version 15.
RESULT: Three hundred and ninety-two participants had responded to all questions they were asked
(response rate = 92.8%). One hundred and five (26.8%) patients had negative attitude to medical
students’ involvement in their health care. The proportion of patients’ having positive attitude towards
students was slightly reduced from medical to surgical and to gynecology wards 77.4%, 72.0%, 69.2%
respectively. Patients who had previous interactions with students were more likely to have negative
attitude (AOR (95% CI) = 1.72(1.03, 2.87). The odds patients admitted in gynecology and obstetrics
ward to prefer female students to care for them was higher (AOR (95% CI) =1.93(1.13, 3.30).
CONCLUSION: Almost half of the patients admitted to Tikur Anbessa Specialized Hospital objected to
clinical procedures on them even physical examination, hence developing clinical skills in TASH
might be challenging for the majority of students. The challenge might be worsened for male students
in gynecology wards.
KEYWORDS: Patients’ attitude, Medical students, Medical Education, TASH

INTRODUCTION students, their understanding of the roles and

responsibilities of students, the nature of their
The most important function and aim of a medical problem and the student’s gender (1, 2).
university hospital is to educate medical students. Previous studies found out that patients generally
As these students are the future health accept medical students' involvement in their
professionals, they should develop skill with hospital and outpatient care. A study in
direct participation in health care activities under Newcastle and London showed that 95% patients
the supervision of responsible professionals. The were happy with students to be present during an
patients' willingness and comfort level in examination, but their consent depended on the
involving medical students in their care may be clinical scenario they had. Another study in
affected by their previous experiences with these London Gynecology Clinic showed that the
Arba Minch University, Arbaminch, Ethiopia, Email: [email protected]
159 Ethiop J Health Sci. Vol. 23, No. 2 July 2013

women’s attitude differed according to the sex of the study, single population proportion formula
the student, with a preference for female was used with the assumptions of expected
students in all types of interaction (3, 4). proportion of patients having negative attitude to
The study conducted in London STI Clinic medical students involvement in their health
found out that female patients were less likely care is 50%, desired precision of 5%, 95%
than male patients to feel comfortable with a confidence level and 10% none -response rate
male student (5). On the other hand, a study in are considered. With these assumptions a total of
Israel showed that 15% would insist on advance 422 adult patients admitted to TASH in medical,
notification of the presence of a student, and surgical and gynecology wards during the study
33.6% would refuse to be examined by a student period directly involved in this study. Samples
without a doctor's presence (6). were proportionally distributed to number of
On the contrary, studies in Marlborough beds in each ward and available patients in each
Hospital and Pennsylvania indicated that many ward during the study period were involved
patients had no preference regarding medical (convenient sampling). Patients only aged above
students’ participation. The most common 18 years, stayed more than three days in the
reasons for feeling uncomfortable with students ward and whose health status allowed them to
were privacy concerns and poorer quality of care communicate were involved from the specified
(7, 8). Studies in Saudi Arabia found out that the wards.
majority of the patients preferred the students Data were collected via interview
with the physician and during physical conducted by trained data collectors. Data
examinations (56.9 % and 64% respectively). collectors were nurse students. Data collectors
One of these studies indicated that 55% believed were not in clinical practice at the time of data
that they had the right to refuse students collection in data collection site. At the time of
involvement (2, 9). interview they did not wear gown or any
University hospitals in Ethiopia are crowded indicator their status or profession. The tool
with their own students and many students (questionnaire) has been adopted from previous
coming from many other private and studies (2, 5, 10, 11). It was first prepared in
governmental medical universities and colleges. English and then translated to Amharic and back
Tikur Anbessa Specialized hospital is a public to English. The tool was pre-tested with 10% of
referral, teaching hospital with more than 500 sample size (42 patients) at Princess Zewuditu
beds. Due to this status of the Hospital, students Hospital. Interview was conducted as patients
are being placed to this hospital. Medical were on their bed and at the moment students
students from domestic and overseas universities were made to leave the room.
and colleges come to this hospital for Data were processed using SPSS version
professional practices. 15. Associations between dependent and
A single patient in Tikur Anbessa independent variables were assessed and
specialized hospital may be forced to interact presented using logistic regressions. P-values
with many students who have different less than 0.05 were considered to be statistically
knowledge, skills, specialties and inquiry. This significant in all cases of association analysis.
study aimed to assess admitted patients’ attitude
towards medical students’ involvement in their RESULTS
health care at Tikur Anbessa Specialized
hospital from April to May 2010. In this study, 422 voluntary patients admitted at
TASH were interviewed. Among these patients,
SUBJECTS AND METHODS 392 responded to all questions they were asked.
The mean age of the participants was 35 years.
This hospital based cross-sectional quantitative The mean and median hospital stays with current
study was conducted from April to May 2010 in admission were 16 and 10 days respectively, the
Tikur Anbessa Specialized hospital (TASH), minimum being 3 days. Among all study
Ethiopia; Addis Ababa. To determine the participants, 227 (57.9%) were females. Two
number of patients (study subjects) required for hundred and thirty (58.8%) of the participants
 Patients’ Attitude towards Medical… Worku A 160

knew that the hospital (TASH) where they were (78%) of the study participants responded that
admitted to that time was a teaching hospital. they would not refuse if students asked them
Two hundred and thirty-one (58.9%) of the questions but 45.2% would object to be
participant patients had previous exposure with examined by the students. Only 11.7% of the
students in clinical practice. participants could discuss without a feeling of
Nearly half (48.5%) of the participants humiliation about their alcohol intake and
reported that they had the right to refuse the extramarital sexual activities if students asked
involvement of students in their health care. them. Among 392 study participants, (70.8%)
Two hundred and seventy-eight (70.9%) of the would prefer students with their gender.
participants would not object to being physically
examined at the presence of students. Majority

Table 1: Patients’ Attitude towards Medical Students’ Involvement in Health Care in TASH, Ethiopia,
2010 (N= 392).

Questions/Statements Yes No
Freq. % Freq. %
Do you believe you have the right to refuse students 190 48.5 202 51.1
involvement in your care?
Do you object to the presence of students during your 114 29.1 278 70.9
physical examinations?
Do you object if the student only asks you questions? 89 33.7 303 77.3
Does general appearance and manner of a student affect 381 81.1 74 18.9
your co-operation with them?
Do you object if the student examines you? 177 45.2 215 54.8
Do you prefer to be informed in advance that a medical 242 61.7 150 38.3
student will be present during your clinical examination?
Do you prefer that the student be of your gender? 114 29.1 278 70.9
Do you feel difficulties in discussing your personnel 296 75.5 96 24.5
history with student?
Do you feel embarrassed when doctor examines your 115 29.3 277 70.7
genitalia in front of students?
Do you feel humiliated if you are asked questions about 46 11.7 346 88.3
alcohol intake and extra marital sexual activities?
Do you cooperate with medical and nurse students as you 282 71.9 110 28.1
cooperate with your physician and nurse?
Is your cooperation with medical and nurse students 319 81.4 73 18.6
affected by your health status?
Do you feel uncomfortable if students come to you to care 101 25.8 291 74.2
for you?

The proportion of patients’ having positive attitude difference was not seen in patients from
attitude to medical students were vaguely any age group and residence. The majority of the
reduced from medical to surgical and to patients in each ward had positive attitude
gynecology wards, i.e. 77.4%, 72.0%, 69.2% towards medical students. One hundred and
respectively. A larger proportion of patients who forty-four (36.73%) individuals of the total study
were more educated had negative attitudes than participants had negative attitude from surgical
less educated patients. Statistical significant ward followed by medical ward.
161 Ethiop J Health Sci. Vol. 23, No. 2 July 2013

150 Attitude
Positive Attitude

Negative Attitude

100

Count
36.73
%

50 24.49
%
14.29
11.99 %
%
7.14% 5.36%
0
Medical ward Obstetrics and gynecology Surgical ward
ward
Wards patients admitted

Figure 1: Patients' Attitude towards medical students involvement in three wards of TASH 2010 (N = 392)

Attitude differences were observed between who had previous interaction with students were
patients who knew the hospital was a teaching found to show no resistance to physical
hospital and who did not; among patients who examination by students.
knew the hospital was teaching, 68.8% had Patients’ preference for students’ gender in
positive attitude as compared with 79.5% who gynecology ward were found to be higher than
did not knew the hospital was a teaching one. patients in other wards. Around 37% of the study
Patients who had previous exposure to students participants in gynecology ward, 20.2% and
were more likely to have negative attitude 32.0% in medical and surgical wards respectively
towards medical students’ involvement in their reported they would prefer students of their
health care; AOR (95% CI) =1.72(1.03, 2.87). gender to care for them; (AOR (95% CI) of
Nearly half (45.2%) of the participants gynecology ward was 1.93(1.13, 3.30) when
reported that they had objection to being compared with medical ward. The odds of
examined by students. Among those who knew females to prefer female students appeared higher
the hospital was a teaching hospital, half reported than that of males to prefer male students to care
that they were not willing to be physical for them AOR (95% CI); 1.65(1.00, 2.71).
examined by students, and 60% of the patients
 Patients’ Attitude towards Medical… Worku A 162

Table 2: Patients’ Attitude to Health Science students cross tabbed with Patients Knowledge and
previous interaction with students in TASH 2010 (N = 392).

Variables Positive attitude to health science students

Yes No COR(95%CI) AOR(95% CI)

Frequency %* Frequency %*
Knew the Yes 159 68.8 72 31.2 1.00 1.00
hospital (TASH)
was teaching No 128 79.5 33 20.5 1.75(1.09, 2.81) 1.35(0.78, 2.31)
hospital?
Had previous Yes 105 65.2 56 34.8 1.00 1.00
exposure to
students in No 182 78.8 49 21.2 1.98(1.26, 3.11) 1.72(1.03, 2.87)*
clinical practice
*statistical significance observed

Table 3: Patients’ gender preference for students to care for them in TASH, Ethiopia 2010 (N=392).

Variables Do you prefer that students be of your gender?

Yes No* COR (95% CI) AOR(95%CI)
Freq. (%) Freq.(%)
Wards Medical 25(20.2) 99(79.8%) 1.00 1.00
Patient Gynecology 25(36.8) 43(63.2%) 1.86 (1.09, 3.16) 1.93(1.13, 3.30)**
Admitted Surgical 64(32.0) 136(68%) 0.80 (0.45, 1.43) 1.03(0.55,1.93)
38(23.0) 127(77%) 1.00 1.00
Male
Sex
Female 76(33.5) 151(66.5%) 1.68 (1.06, 2.65) 1.65(1.00, 2.71)**
Total 114(29.1) 288(70.9%)
*Do not care whether male or female **association found

DISCUSSION interact more with students, they can become

bored and may observe more errors while
The majority (73.2%) of the patients admitted to students are practicing. This is an alarm for
TASH perceived medical students’ involvement stakeholders working on human health. Medical
in their health care positively; this coincides with practice is an issue of life and death; hence
the studies done in Turkey and UK (13, 1). practitioners should be equipped with adequate
Though it was not statistically significant, it knowledge and skills. Skill is acquired only
seems more educated patients were more likely to through practice; real practice directly on
have a negative attitude to students in clinical patients. Real practice on real patients in TASH
attachment than less educated patents: 44.4% and is facing objections from patients. If no measure
17.9% of patients with 1st degree and only read is taken, the level of objection may become worst
and write respectively. as the community interacts more with students.
Patients’ previous interaction with medical More than three fourth of the study
students was found to be the determinant factor participants responded that they would not object
for their attitude towards medical students. This if students asked them questions, but nearly half
finding is inline the study done in Pennsylvania of participants reported that they would not be
in 2007 (8). This might be because as patients willing to be examined by students. The
163 Ethiop J Health Sci. Vol. 23, No. 2 July 2013

investigators of this study share reason given interactions with students, this is an alarm for the
from Marlborough hospital and Pennsylvania; universities and colleges which are training
most common reasons for objecting against medical students.
students’ involvement in physical examination Almost half of the patients admitted to Tikur
were privacy concerns and poorer quality of care Anbessa Specialized Hospital had objection to
(7, 8). This could be one of the dangers of clinical procedures on them even physical
medical education in Ethiopia especially in examination, involving practicing students.
referral and university hospitals. Therefore, developing clinical skills in TASH
A study in the UK found out that patients might be challenging for the majority of students.
were gaining from learning about their conditions The challenge might be worsened for male
while students discussed about their problem students in obstetrics and gynecology wards.
with their teachers; personal satisfaction from Medical educators should thus closely
helping students to learn and receiving "gifts" monitor their students’ especially male students
such as personal gratitude (14). However, practicing in gynecology and obstetrics wards
medical educators and students in Ethiopia are since patients in this wards are more resistant to
discussing in English during bed-side teaching male students.
using lots of medical terms which is totally On the other hand, medical education
impossible or difficult to understand by most stakeholders are advised to work on improving
admitted patients. This may be the other cause for admitted patients’ attitude towards the nature of
patients’ resistance to students’ involvement and medical education and significance of involving
one of the barriers to efforts directed producing medical students in real patient care.
skilled health professionals. It is necessary that Universities and colleges
The majority of the patients in gynecology training medical students consider other
ward objected to physical examination by supportive options for clinical practice like expert
students as compared with patients in medical patients, since patients are resisting students more
and surgical wards. The reason for the resistance as they interact more with students, and as
of patients in surgical and gynecology wards to coverage of medical education is increasing in
physical examination by students may be pain the country, there is going to be more interaction
from the body parts being examined and need for and more resistance, too.
privacy. The finding from Marlborough Hospital
Sexual Health Clinic supports this assumption ACKNOWLEDGMENTS
which found out that the reason for patients’
objection to being by students was concern of I express my heartfelt thanks to Addis Ababa
privacy (7). University, Medical Faculty, Centralized School
Patients admitted to gynecology ward were of Nursing, for sponsoring this study and Ato
more likely to prefer female students to care for Asrat Demisie for his support and advice. Finally,
them. The finding of this study on gender I would like to thank all participants of this study
preference is in line with the findings of a study for responding to all questions they have been
done in London Gynecology Clinic (4). This asked.
implies that female students have more chance to
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