gms | German Medical Science

Introduction & question: Active student participation (ASP) in Clinical Education Wards (CEW) integrates students actively in interprofessional health care teams. By this manner of workplace based learning (WBL) students acquire practical skills and different qualities of professionalism. Previous small scale pilot studies showed that the majority of patients and staff members valued ASP [1], while students" competencies improved in different categories [2]. This study examines the reproducibility of previous studies on a larger scale to come to a better understanding of the impact of WBL on quality of care from patients' point of view.

Methods: CEWs, where final year medical students actively participate in patient care, were implemented in internal medicine, neurology and pediatrics. Students take care of 2-4 patients under close supervision of clinical teachers. Over a six year period (2009-15) all patients completed the Picker Inpatient Questionnaire with questions focusing on patient care, general quality of care and patient-physician relationship complemented with questions to the impact of ASP. Control groups were formed by matching patients treated on regular wards of the same specialty and hospital (CG1) and of other hospitals in Germany (CG2).

Results: Out of 1136 patients being treated by 74 medical students and 13 supervising physicians in 2009-15, 528 patients returned the questionnaire (46.2%). The majority of patients (66%) rated the impact of ASP on quality of care on a CEW as positive. Problem frequency on the CEW was 8-16% lower in patient-physician-interaction (p<0.001), 4-7% lower in general quality of care (p<0.05) while medical treatment success stayed equal (problem frequency 15-16%). 96% of the patients would return to the CEW the next time they would need hospital care.

Conclusion: Our study confirms the results of the CEW-pilot study in three CEW on a substantial larger scale. As seen by the patients, WBL, realized by integration of closely supervised students in the clinical health care team, ameliorates physician-patient-interaction as well as general quality of care without loss of medical treatment success. This study indicates that not only learners but also the "community of practice" including treated patients may benefit from ASP.