The use of patients as student evaluators

Current evaluation of medical students in their clinical clerkships is usually performed by their clinical tutors, and emphasizes knowledge, skills and behavior. However, it is not at all certain that the clinical tutors adequately appreciate the behavioral aspects of the student-patient interrelationship. Since these interactions are not directly observed by the tutors, their evaluation is based largely on second hand information. In the present study, patient opinion regarding student behavior was collected and compared to tutors' evaluation of the student. One hundred and eighty one patients and 31 clinical tutors evaluated 41 medical students during a 6 week internal medicine clerkship, using a specially designed patient questionnaire and tutors' rating form. An analysis of the correlation between tutors' individual rating parameters and the global score revealed high correlation for those parameters associated with clinical knowledge and skills, but lower correlations for parameters associated with students' relationship to patients. The study reveals difficulties associated with the evaluation of students by patients. The process is time-consuming, and introduces tension between students and patients. In addition the patients appeared to be poor discriminators in evaluating medical students. Finally, the study points out that tutors do not assign sufficient importance to the student-patient relationship in the global clerkship score.