Euthanasia in Northern Ireland

Candidates for medical school are encouraged to investigate their chosen career by spending time in general practice prior to applying to university. To investigate the prevalence and nature of this practice I surveyed first year medical students at the University of Leeds during introductory week. The response rate to an initial questionnaire was 63% (135 students). Of these, 59% (79) had spent time in a general practice while at school of whom the majority (61) had sat in during consultations, and 44 had gone on home visits. The amount of time spent in a practice varied from half a day to 200 days, with a median of six days. I asked the 69 students who had spent more than one day in a practice to fill in a second questionnaire and 46 (67%) replied. Of these, 18 students had spent time in the practice in which they were registered as patients. Issues of confidentiality had been discussed with 40 (87%) of these students, usually by a GP or practice manager, though for two students this had been carried out by a receptionist. From conversations with some of the students it was apparent that not all patients were aware of the status of this person ‘sitting in’. Some assumed the school student to be a medical student. Patients were asked to consent but sometimes not until they entered the consulting room. I find this practice worrying for several reasons. Confidentiality is a complex issue discussed at length in the medical undergraduate curriculum before students interview patients. How much of this complexity can school students grasp when introduced to the issue in a short unstructured format, sometimes by receptionists? The Medical Protection Society suggests that patients should be given the opportunity of declining to have a medical student present both before entering the consulting room and again before the consultation begins. This does not always appear to be happening with school students. Previous studies have shown that the majority of patients have either positive or neutral feelings about the presence of medical students1 but 10% of patients said they had left without saying what they wanted to say and 33% found it difficult to talk about personal probelms.2 Given that community-based education of medical students is becoming more widespread, are we not in danger of losing our patients’ goodwill by also expecting them to consent to the presence of school students?