Student doctors and women in labor: Attitudes and expectations

Objective: To compare the attitudes and expectations that obstetric patients and medical students bring to the student-patient relationship in intrapartum care. Methods: Written questionnaires were distributed to obstetric patients who had students assist in their labor and delivery care and to medical students who had completed their clinical clerkship year. Responses of 222 patients and 67 students were analyzed for differences in expectations of student participation and assessment of skills. Results: Responses of medical students and patients were significantly different in all attitudes and expectations studied. One hundred thirty-six (61%) patients compared with 27 (40%) students identified the patients' wish to contribute to the education of students as the most important reason for agreeing to student participation. All patients felt that student participation should be requested rather than assigned, with 194 (87%) patients but only 30 (45%) students wishing to have the student absent from the room at the time of the request. Mean ratings of different student skills tended to be higher from patients (1.3-1.8 on a seven-point Likert scale) than from the students themselves (range 1.6-2.4). Although students' expectations of participation in patient care were high, patients indicated expectations of fairly low levels of student involvement in communication, examination, labor support, and procedures. Conclusion: Students have high expectations for their active involvement in intrapartum care and tend to underestimate the sense of altruism that motivates patients to allow student participation. Patients have low expectations of levels of student participation in their care, but are overall quite satisfied with the skills of the students. These differences highlight the need for the development of educational objectives that clarify student roles in clinical clerkships and the process of informed consent for student participation.