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Am Fam Physician. 1998;57(7):1659-1660

Some studies have shown that precepting medical students decreases physician productivity (ranging from 0.65 fewer patients seen per day to 0.6 fewer patients seen per hour) and causes an increase in the length of the physician's work day (up to 50 minutes per day). Frank and associates conducted a cross-sectional study to determine how the presence of a medical student affects physician productivity and patient satisfaction during an office visit.

Sixteen physicians were observed during 369 visits with patients without students present and during 83 patient visits with students present. A research nurse was present during the office visit to make observations regarding physician behavior, services delivered and length of time the physician spent with the patient. An exit questionnaire was also completed by the patient to determine the patient's level of satisfaction with the office visit.

Students were significantly more likely to see minority patients and those who were on Medicaid. Physician behavior was significantly different when a student was present in four out of 10 areas observed. When students were present, history taking was shorter, feedback to the patient was shorter, fewer patient questions were answered and more time was taken setting up the structure of the office visit (i.e., setting expectations for the visit). There was no significant difference in all other physician behaviors observed, including physicial examination and health education. The amount of time the physician spent with the patient was not significantly different when a student was present: with-student encounters averaged 9.9 minutes and without-student encounters averaged 10.3 minutes. Total patient satisfaction did not decrease when a student was present.

The authors conclude that although a physician's work day may be longer and his or her productivity may be decreased (according to other studies), patient care does not suffer when medical students are present during a patient examination. Patients remain satisfied, and their expectations continue to be met, even when the physician serves as a community preceptor.

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