Skip to main content

Effect of medical student teaching on patient satisfaction in a managed care setting

Abstract

OBJECTIVE: To measure the effect on patient satisfaction of medical student participation in care and the presence of medical student teaching.

DESIGN: Prospective cohort study.

SETTING: Eight outpatient internal medicine departments of a university-affiliated HMO in Massachusetts.

PATIENTS: Two hundred seven patients seen on teaching days (81 patients who saw a medical student-preceptor dyad and 126 patients who saw the preceptor alone), and 360 patients who saw the preceptor on nonteaching days. Five hundred (88%) of 567 eligible patients responded.

MEASUREMENTS AND MAIN RESULTS: Thirteen closed-response items on a written questionnaire, measuring satisfaction with specific dimensions of care and with care as a whole. Visit satisfaction was similar among patients on teaching and nonteaching days. Ninety-one percent of patients seeing a medical student, 93% of patients seeing the preceptor alone on teaching days, and 93% of patients on nonteaching days were satisfied or very satisfied with their visit; less than 2% of patients in each group were dissatisfied with their visit. Satisfaction on all measured dimensions of care was similar for patients seeing a medical student, patients seeing the preceptor alone on teaching days, and patients seeing the preceptor on nonteaching days.

CONCLUSIONS: Medical student participation and the presence of medical student teaching had little effect on patient satisfaction. Concerns about patient satisfaction should not prevent managed care organizations from participating in primary care education.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Council on Graduate Medical Education. Third report: improving access to health care through physician workforce reform: directions for the 21st century. Rockville, Md: Health Resources and Services Administration; 1992.

    Google Scholar 

  2. 2.

    Schroeder SA. Expanding the site of clinical education. J Gen Intern Med. 1988;3(suppl):S5–14.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Perkoff GT. Teaching clinical medicine in the ambulatory setting: an idea whose time may have finally come. N Engl J Med. 1986;314:27–31.

    PubMed  CAS  Article  Google Scholar 

  4. 4.

    Moore GT, Inui TS, Ludden JM, Schoenbaum SC. The “teaching HMO”: a new academic partner. Acad Med. 1994;69:595–600.

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Ott JE. Medical education in a health maintenance organization: The George Washigton University Health Plan experience. HMO/PPO Trends. 1992;5:6–11.

    Google Scholar 

  6. 6.

    Kirz HL, Larsen C. Costs and benefits of medical students’ training to a health maintenance organization. JAMA. 1986;256:734–9.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Veloski J, Barzansky B, Nash DB, Bastacky S, Stevens DP. Medical student education in managed care settings: beyond HMOs. JAMA. 1996;276:667–71.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Swanson AG. HMOs have an educational obligation. HMO Practice. 1988;2:125–8.

    Google Scholar 

  9. 9.

    Richardson P, Curzen P, Fonagy P. Patients’ attitudes to student doctors. Med Educ. 1986;20:314–7.

    PubMed  CAS  Google Scholar 

  10. 10.

    King D, Benbow SJ, Lye JE, Lye M. Attitudes of elderly patients to medical students. Med Educ. 1982;16:17–21.

    Article  Google Scholar 

  11. 11.

    York NL, DaRosa DA, Markwell SJ, Niehaus AH, Folse R. Patients’ attitudes toward the involvement of medical students in their care. Am J Surg. 1995;169:421–3.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    DaRosa D, Dunnington G, Sachedeva A, et al. A model for teaching medical students in an ambulatory surgery setting. Acad Med. 1992;67:S45–7.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Frank SH, Stange KC, Langa D, Workings M. Direct observation of community-based ambulatory encounters involving medical students. JAMA. 1997;278:712–6.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    O’Malley PG, Omori DM, Landry FJ, Jackson J, Kroenke K. A prospective study to assess the effect of ambulatory teaching on patient satisfaction. Acad Med. 1997;72:1015–7.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Corrigen JM, Thompson LM. Involvement of health maintenance organizations in graduate medical education. Acad Med. 1991;66:656–61.

    Article  Google Scholar 

  16. 16.

    Sheets KJ, Caruthers BS, Schwenk TL. Assessing patients’ satisfaction with care provided by residents in an academic HMO setting. Acad Med. 1990;65:482–3.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Dorsey JL. The prepaid group practice plan in the education of future physicians: initial efforts at the Harvard Community Health Plan. Med Care. 1973;11:12–9.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Siebert JH, Strohmeyer JM, Carey RG. Evaluating the physician office visit: in pursuit of a valid and reliable measure of quality improvement efforts. J Ambulatory Care Manage. 1996;19:17–37.

    Google Scholar 

  19. 19.

    Barnett GO, Justice NS, Somand ME, et al. COSTAR: a computer-based medical information system for ambulatory care. Proc IEEE. 1979;67:1226–37.

    Article  Google Scholar 

  20. 20.

    Barnett GO. The application of computer-based medical information systems in ambulatory practice. N Engl J Med. 1984;310:1643–50.

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Bruster S, Jarman B, Bosanquet N, Weston D, Erens R, Delbanco TL. National survey of hospital patients. BMJ 1994;309:1542–6.

    PubMed  CAS  Google Scholar 

  22. 22.

    Kravitz R. Patient satisfaction with health care: critical outcome or trivial pursuit? J Gen Intern Med. 1998;13:280–1.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Steven R. Simon MD, MPH.

Additional information

This work was supported by a grant from the Harvard Pilgrim Health Care Foundation. The work of Dr. Simon was supported by a National Research Service Award (T32 PE11001-09).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Simon, S.R., Peters, A.S., Christiansen, C.L. et al. Effect of medical student teaching on patient satisfaction in a managed care setting. J GEN INTERN MED 15, 457–461 (2000). https://doi.org/10.1046/j.1525-1497.2000.06409.x

Download citation

Key words

  • Medical students
  • patient satisfaction
  • education