Medical student experience of London general practice teaching attachments

Forty-eight students kept a log diary of activities during their central London general practice teaching attachments associated with the Department of Primary Health Care of University College and Middlesex School of Medicine. The students each saw on average 96 patients per week, of whom 69% were discussed by the general practitioner with the student after the consultation. Students spent an average of 21.5 hours a week sitting in with the general practitioner. While most of this time was as a passive observer, the students were also able to participate more actively, personally taking histories for a median of 1.25 hours a week and personally examining patients for a median of 1.7 hours a week. During these periods of active involvement each student personally took a mean of 10 short and 2.5 long histories per week and performed a mean of 25.5 short and 1.2 long examinations per week. General practitioners to whom the students were attached spent a mean of 4 hours a week on (patient-oriented) teaching. The tuition was highly rated by the students in terms of both usefulness and stimulation. Students also received a mean of 2.3 hours a week of teaching from other members of the primary health care team, which was somewhat less well received. Areas for improvement were: the relatively few home visits (median of 6 per week) per student; the limited time students spent on self-education (average of 65 minutes per week); and the few practical procedures performed by the students. Students could also be encouraged to play a more active role in examining and interviewing patients.