How do patients really feel about students and residents?

During my residency training in plastic surgery, I remember spending time in the offices of some of our community faculty members. These were invaluable opportunities to gain exposure to the field outside of the academic university hospital, where things were quite different.

The university was a large organization where several residency programs and hundreds of trainees were not just seamlessly integrated into the workings of the hospital, but actually required to keep the place running. Most of the patients coming there had an expectation that students and residents would be observing and taking part in their care, so they were not surprised to see them. Rounds on inpatient wards consisted of small armies made up of an attending physician, several residents, and even more medical students, with each battalion diving in and out of patient rooms to make their visits and plan each patient’s care. This accepting attitude toward trainees and students trickled over into the outpatient setting as well, where many patients awaited to see if a student, resident, or the attending would be seeing them first.

In sharp contrast, our rotations with community faculty members put us in hospital systems and settings where residents and students were less likely to be present. This was especially evident in the outpatient setting, where the smaller private offices of these local physicians functioned with a lean complement of staff and no resident help. For this reason, when a resident did appear at office hours, it wasn’t unusual for them to be met with some surprise and confusion.

It was during these rotations that I became very interested in how the patients perceived the presence of residents and students. I noticed for certain patients, especially if they were being seen for cosmetic concerns, some of the community faculty would not include us in their consultations. While it was never actually explained to us, I assumed we were excluded because the physician was concerned about surprising the patient who had come in for a cosmetic concern. But as I thought about it more, I also wondered if patients being seen for cosmetic reasons had different perceptions about trainee participation.

After my residency training, I had the pleasure of spending several years working as a faculty member at a large state-funded university hospital. During this time, I too, like the attending physicians who trained me, spent almost every day with a shadow of brilliant trainees and took them everywhere I worked — to the operating room, on rounds, and to my clinics. It was in this setting that we revisited the question of how patients perceived resident participation in their care.

To do this, we randomly surveyed patients who were being seen for the first time in either university or private centers regarding their attitudes toward resident participation in different aspects of their care. The results, as recently presented in the Journal of Surgical Education, revealed an interesting twist. While patients being seen for reconstructive concerns were more open to resident involvement than those who were being seen for cosmetic concerns, the part of the patient’s body being evaluated also played a significant role in shaping their attitude toward resident involvement. Patients being seen for breast-related issues were less open to having residents as part of their care. However, despite these findings, neither group of patients believed that resident participation would ultimately lower the quality of the care they would receive.

These findings resonate with me now, especially since I left my university position and started my own private practice a year ago. While I no longer can count on a resident or student being a few steps away, I do occasionally have a trainee come to work with me. I owe my years in academia for the pleasant feeling their presence instills within me. I also know that my patient, regardless of the reason which has brought them to see me that day, will also be likely to have a good feeling if I happen to have a resident working with me.

Ergun Kocak is a plastic surgeon.

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