1. & Patient Interest Educational Interest

2. Fact MedEd need pt. contact MedEd need pt. contact pt. feel positive to participate pt. feel positive to participate  not always

3. Research ward: Med, Sx, OB ward: Med, Sx, OB 114 sample, questionnaire 114 sample, questionnaire result: result:  mean age 47.9  M : F = 45.6 : 54.4  lower socioeconomic  hospital stay 3-7 d

4. Result 32.5% : student = doctor 32.5% : student = doctor positive attitude positive attitude  > 85% to Hx and PE ventilate | supportive | informative | non- discriminate ventilate | supportive | informative | non- discriminate  75.4% to bedside teaching attention | understanding | communication attention | understanding | communication

5. Result negative attitude negative attitude  22-24% : procedure & competence confidence | skillful | supervision confidence | skillful | supervision  21% : advice short duration | practicality short duration | practicality

6. Result: Gender male pt male pt  84.6% : any gender female pt female pt  40.3% : female student  56.5% : any gender

7. Result: Why participate ? better quality of treatment better quality of treatment more care more care more information more information more contact time more contact time

8. Result: Factors Affect Attitude positive positive  older (> 60yr)  lower education (1 ry school)

9. Fact MedEd need pt. contact MedEd need pt. contact pt. feel positive to participate pt. feel positive to participate  not always

10. Fact Pt. have the right to choose Pt. have the right to choose  pt. exercise their right  pt. right is violated no informed consent no informed consent late permission sought, difficult to refuse late permission sought, difficult to refuse

11. Why avoid informed consent? myth: negatively affect the pt decision myth: negatively affect the pt decision  research: randomized trial same participation same participation increase satisfaction increase satisfaction myth: time restriction myth: time restriction  didn’t need much time

12. Barrier to Participation nature of pt. problem nature of pt. problem previous bad experience previous bad experience negative preconception negative preconception  level of confidentiality  student status lack of choice lack of choice  not enough time to think staff behavior & communication staff behavior & communication

13. What increase satisfaction? earlier notification earlier notification more specific information more specific information allowing them to see the doctor alone allowing them to see the doctor alone

14. Detail to Inform What? What?  student: sex, number, status  level of confidentiality: medical note  what will be done.. Where? without student being present Where? without student being present When? earliest When? earliest How? verbal | document | signature How? verbal | document | signature By whom? trained staff By whom? trained staff

15. Example 1. The clinic was involved in the clinical training of medical students 2. The training of future doctors depended on the participation of patients 3. The skill of the gynecologist whom the pt. would meet resulted from previous pt. participation in training 4. Participation in the training was strictly voluntary

16. Students’ View: Unethical Act felt pressure to act unethically felt pressure to act unethically  47% (48/103)  35% (17/48) : conflict between medical education and patient care witness a clinical teacher act unethically witness a clinical teacher act unethically  61%

17. Policy students are not doctor students are not doctor verbal informed consent verbal informed consent pt under GA | incompetent pt under GA | incompetent procedure: consent & supervision procedure: consent & supervision confidentiality confidentiality refuse unethical act refuse unethical act