Overview and demographics
In the questionnaire, age demographics were divided into seven categories; There was a separate category for parents/guardians of inpatient children. Questionnaires were issued to inpatients at 25 wards and distributed according to the duration of the respective internship during the training (see Table 1).
Table 1 Participant demographics, including age and gender, and participant breakdown by specialty
Two hundred participants completed the questionnaire, while an additional 34 inpatients (14.5%, 3–11 per recruiter) declined to participate despite meeting the inclusion criteria. Reasons for refusal were not formally collected, but when given, they included fatigue, pain, malaise, childcare needs, and concerns about upcoming medical reviews and investigations.
One hundred and seventy-seven participants (89.8%) had received at least one COVID-19 vaccination. Fifty-two participants (26.0%) reported having been previously infected with COVID-19, while 48 (24.0%) had a confirmatory test. 120 participants (60.3%) had previously spoken to or been examined by a medical student.
Willingness to speak to and be examined by a medical student
169 participants (85.4, 95% CI 79.5 to 89.8%) answered the opening question “I am pleased to speak to a medical student and allow him to examine me” with a positive response. The positive response continued after the reflection questionnaire with 174 participants (87.9, 95% CI 82.3 to 91.9%) happy to see the students. The Wilcoxon signed rank test showed that reflecting on the risks and benefits of direct contact with medical students did not produce a statistically significant change in response (p=0.189). Each time this question was asked, answers were missing from two individual participants.
Nevertheless, 63 participants (32.1%) changed their answer (Fig. 1). Of those who changed, 37/63 participants (58.7%) changed to a more positive response and 26/63 (41.3%) to a less positive response. For the majority (40/63, 63.5%), this reflected only a change in the degree of their original response (e.g. from “fairly satisfied” to “satisfied”) and not a change in category (e.g. from “satisfied” to “neutral”) or unhappy). Furthermore, 12/21 (57.1%) of the participants with an initial neutral response were happy to see the students after our reflective questions, while 0/21 (0%) from the neutral group became unhappy. Of those initially unhappy to see students, 2/8 (25.0%) became happy. Of those initially satisfied, 5/167 (3.0%) and 4/167 (2.4%) later reported being neutral or unhappy to see students.
No significant change in willingness to see medical students for reflective questions. Mapped responses of participants to the question “I am pleased to speak to a medical student and allow him to examine me” before and after the questionnaire. Analysis was performed using a Wilcoxon signed rank test
Medical students completed 77 (38.5%) of the questionnaires compared to physicians who completed 123 (61.5%). A greater proportion of participants gave an initial positive response to a medical student visit when the questionnaire was completed by a medical student rather than a physician (92.1% vs. 81.1%). However, this association was not statistically significant (p = 0.298).
Questions to immediately weigh the risks and benefits of visiting medical students
Questions and statements designed to explore both the clinical and educational benefits of seeing medical students elicited mostly positive responses. For example, 187 participants (93.5%) agreed with the statement “Students need to talk to patients so that they can become excellent doctors in the future”, 184 participants (92.0%) agreed “Students need to examine patients if they are in the hospital to see what people look like when they are sick’, and 168 participants (84.0%) also agreed that ‘being in the hospital can sometimes be boring, scary or confusing. A conversation with a medical student can be interesting and helpful.”
Alternative suggestions such as “Instead of coming to the wards, I think there are safer ways for students to practice, e.g. e.g. telephone conversations with patients or examining actors”, only 32 participants (16.0%) agreed, while 144 (72.0%) disagreed with this statement. Also, respondents did not appear to be more concerned about “getting COVID” while in hospital compared to the community (29.8%). [95% CI: 23.8 to 36.7%] versus 33.6% [95% CI: 27.4 to 40.5%]who respond as concerned, very concerned, or extremely concerned). When asked to consider other non-clinical ward visitors, the statement “I think the number of people coming into the ward should be tightly controlled” showed a variety of responses, with 51 (25.6%) of the Participants agreed with ‘very limited visit’ An equal number disagreed, choosing ‘anyone can visit but should do a COVID test first’.
Following the second self-report willingness question, we examined how the clinical benefit of student activities affected patient attitudes, stating, “Even though younger students do not come on the wards, I think older students are allowed on the wards, when they help doctors by doing tasks like taking notes, taking blood tests and putting cannulas”. This showed a positive response, with 185 participants (93.4%) agreeing or strongly agreeing with this statement. Four participants (2.0%) rather or not at all rejected medical students being allowed to work on the wards in this capacity.
Perception of the risk of infection and consequential damage from COVID-19
When asked “If I am exposed to someone with COVID in the hospital, I think my chances of getting infected are….” participants of all self-categorized levels of perceived risk gave a very positive response to being seen by a medical student . Of those who felt they were at the highest risk of contracting COVID-19 (answered “high chance,” “very high chance,” or “would definitely get COVID-19”), 42/50 were (84.0%) willing to see a medical student (Fig. 2).
A high perceived risk of contracting COVID-19 does not significantly affect willingness to see medical students. Bar graph of participants’ willingness to see medical students (second question) versus their perceived risk of contracting COVID-19 exposure, using the statement “If I am exposed to someone with Covid while I am in the hospital, I estimate my chances of infection are..”
When asked, “If I do get Covid now because of my age and underlying medical conditions, I think…” over 70% of participants responded positively to a medical student visit, across all levels of perceived harm. Additionally, in the subgroup that rated themselves as having the highest risk of injury (severely unwell, severely unwell and could die, or I will die), 41/47 (87.2%) remained willing to move away from to have a doctor examine the student (Fig. 3).
Positive responses to medical student visits despite recognized risk of injury and death. Bar graph of participants’ willingness to see medical students (second question) versus their perceived risk of harm from COVID-19 if infected, using the statement “Due to my age and underlying medical conditions, if I do indeed get Covid now, I think “
For clarity of illustration in Figs. 2 and 3, responses to the initial willingness question on the Likert scale were grouped into categories of; happy (those who chose “very excited,” “like to be seen and examined,” or “fairly satisfied”)), neutral (those who “don’t mind”), and unhappy (those who selected “a bit unhappy”, “don’t like to be examined” or “no, I don’t want to be examined by a medical student”).
Reduce perceived risks – improve willingness to visit medical students
Regarding alternatives to inpatient contact, 170 participants (86.7, 95% CI 81.0 to 91.0%) responded positively to being seen and evaluated by a medical student in outpatient clinics once their health had improved. The Wilcoxon signed rank test showed that there was no statistically significant change in response when considering an outpatient clinic setting versus an inpatient setting (second question – p=0.197). However, narrowing down to those who were not happy about seeing medical students during an inpatient stay, 8/10 (80.0%) of those were unhappy and 7/14 (50.0%) of those were Wards were neutral about visiting students in the hospital, reporting that they were pleased to see students in the outpatient clinic.
We asked participants to select other infection control measures that they would feel more comfortable using when visiting medical students, as shown in Fig. 4. They were able to provide multiple responses regarding the adequacy of current infection control measures and methods used to assess COVID-19 transmission, including lateral flow testing and COVID-19 contacts. Considering current infection control guidelines, 152 participants (76.0%) said they would feel happier to see students fully vaccinated against COVID-19, 143 participants (71.5%) wanted medical students Wear masks and an additional 122 (63.5%) wanted students to wear gloves and gowns when in contact with patients. In addition, 95 participants (47.5%) felt reassured that medical students had no cold symptoms. For the assessment of the medical students’ current risk of COVID-19 infection, 110 participants (55.0%) wanted a negative LFT result from the medical students on the same day, while 136 (68.0%) wanted a negative LFT result from a of the three frequencies offered wanted . 84 (43.8%) felt reassured knowing the medical student had no known contact with anyone who was COVID-19 positive in the past week.
Infection control measures for medical students as advocated by patients. Bar chart indicating the frequency of participants supporting various current infection control measures for medical students (masks, gloves and apron, vaccination status and no cold symptoms) and the preferred measures for assessing the risk of COVID-19 infection (frequency of lateral flow test and previous COVID-19 contact)