Are we missing something? What are medical students missing out on, and why, when they are excluded from doctor patient encounters in general practice?

Background: Medical training uses the apprentice model,
but medical students are excluded from doctor patient
encounters during placements so miss out on learning
opportunities. There is little understanding of why patients
do not want medical students present. Consent from
patients is essential prior to encounter, but where consent
is asked, and by whom varies, and may be repeated, or
anticipated on the patient's behalf. Research in Australia
found that 70 -90% of patients said they would "never
refuse" to have a student in the room. But this is not what
our students are telling us occurs during their placements.
Method: We are collecting data from medical students
during their GP placements to explore why they are not
being allowed into consultations. Each participant is asked
to complete a short survey each time they are excluded
from an encounter during their GP placements.
Quantitative information is collected about the
demographics of the student, GP, practice, and patient;
also who asked for consent, and when; plus the frequency
of exclusions. Qualitative data is provided by free text
answers about the reasons for exclusion, the nature of the
consultation, any cultural issues, and the students feelings
regarding exclusion.
Results: Male students are more likely to be excluded by
male GPs seeing female patients, however male students
with female GPs were excluded more frequently.
The age range of excluded patients was 20 to 50 years
Most students were present when consent was asked, this
was mostly asked by the doctor, in the waiting or
consulting room, but many were not. It was more likely for
the doctor to ask the student to leave than the patient.
Mental and sexual health were commonly quoted reasons
for exclusion.
Conclusion: It is important to better understand student
exclusions from patient encounters to address the gaps in
clinical experience. It may be possible to stop some of the
exclusions, for example if the patient's decision is
anticipated incorrectly.
Take-home message: Improved insight about the issues
causing student exclusions, will improve our ability to
either prevent this happening, or compensate the lost
learning