Medical student learning is dependent on an unwritten agreement between patients and the medical profession, in which students “practise” upon real patients in order that, when they are doctors, those same patients will benefit from the doctors’ skills. Given the increasing propensity for patients to refuse to take part in such learning, there is a danger that doctors will qualify without being truly competent. As patients, we must all ask ourselves, when asked to take part in medical teaching: if this student/trainee doesn’t learn now, on me and under supervision, how will the person be truly competent next time, when this is for real, and the patient might be me or my loved one?
We argue that a new and more explicit agreement is needed, in which the default should be that all patients are willing to help in the education of medical students, while we ensure that all such students are already competent in simulation before first practising upon real patients.
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Competing interests: HD, JP and NR are all employees of the University of Birmingham and all are involved in the education and training of medical students as part of their job descriptions.
↵iWe thank Lisa Schwartz for suggesting that our overall argument might be strengthened by adding, at this point, that when a student or trainee is present, the patient may actually benefit from the presence of two healthcare providers as opposed to one. Our reluctance to use this argument was primarily due to the fact that to do so would undermine the point we make about the doctor–patient interaction being patient-centred. Even if the patient did benefit from the presence of an additional carer, it would still be the case that the focus of the interaction ceases to be wholly on the patient, and the consultation becomes an educational, as well as a clinical, enterprise. Furthermore, while the patient might well decide that on balance she is better off (trading two carers off against being an educational tool), we intend our argument to be independent of this kind of immediate “utility” calculation, and focus instead on the patient’s longer-term interests and obligation.
↵iiWe thank one of the reviewers for clarifying this point.