The patient, the doctor, the students and the overcrowded room

This article was exclusively written for The European Sting by Mr. José Ganicho, a 5th-year medical student from the Beira Interior University, Member of the Medical Students Association from Portugal, ANEM-Portugal, National Member Organization of International Federation of Medical Students Associations. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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Imagine entering an overcrowded room, full of medical students, all eager to practice their clinical skills. Imagine that all of the students in the room want to ask you questions to know what brings you to the hospital. Which patient feels comfortable being asked a number of questions from a number of students, being exposed, being vulnerable and for some patients, being in one of the worst days of their lives? No one feels comfortable. Not even the medical students in the room. According to the WMA, “medical education consists of training aimed at ensuring physicians acquire the competencies, skills and aptitudes that allow them to practice professionally and ethically,” (1) However, before they are able to practice independently, every physician has to complete a formal program of supervised clinical education, learning from other doctors and contacting with real-life patients in health care facilities. The overcrowded room is not just a hypothetical scenario, but a reality that most physicians, patients and medical students face every day. When we exceed the reasonable student to tutor ratio, there are a number of negative effects for all the people in the room. The patient is more exposed, vulnerable and more likely to avoid mentioning some details due to being uncomfortable and unable to share in an overcrowded room. The physician will have a harder time conducting the clinical interview and even explaining and answering all the questions of the students. Finally, studies show that medical schools with more admissions might be more susceptible to lower scores of student satisfaction and high student-tutor ratios in clinical rotations may reduce the quality of the learning experiences. (2) Furthermore, tackling the student to tutor ratio issue is not a problem that affects only medical students, but also physicians, patients and communities in general. This issue also connects to the 2030 Agenda for Sustainable Development, highlighting the importance of this topic to the realization of SDG4 (Quality Education) and SDG 3 (Good Health and Well-Being). For us to achieve this optimal ratio and assure a quality education, as the WFME stated, we have to review the size and nature of student intake in consultation with authorities responsible for planning and development of human resources in the national health sector, while regulating it to meet the health needs of the community and society. (3) Only by knowing our prospective community health needs can we truly find this number in a manner that is sustainable for our Health Systems. Finally, as we can see, achieving an optimal student to tutor ratio is not just a complex question that needs to be answered by each medical school independently but a problem that needs a collective local, national and international solution. In this process, all the relevant stakeholders from the Education and Health sector have to tackle this issue together, taking into consideration the Health Systems and Medical Schools resources, capabilities and overall sustainability, while addressing the local and national health needs of our communities. References

• WMA Statement on Medical Education, Adopted by the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 and revised by the 68th WMA General Assembly, Chicago, United States, October 2017
• Grilo Diogo P., Moreira A., Coimbra A., Coelho Silva A., Nixon Martins A., Mendonça C., Carvalho C., Almeida G., Almeida H., Garcia Moreira I., Rodrigues M., Goulão M., Vasconcelos R., Vicente R., Magano S.; Study on Portuguese Medical Schools’ Learning Conditions: A National Analysis on Student Satisfaction, Student-Tutor Ratios and Number of Admissions
• WFME; Basic Medical Education, WFME Global Standards for Quality Improvement: the 2012 revision

Available at:

• https://www.wma.net/policies-post/wma-statement-on-medical-education/
• https://www.ncbi.nlm.nih.gov/pubmed/27649013
• https://www.um.es/documents/1935287/1936044/Revision_of_Standards_for_Basic_Medical_Education_FINAL_260912.pdf/5866f7af-f7fc-4f9a-a7e6-eb054b7795c3

About the author José Ganicho is a 5th-year medical student from the Beira Interior University, Member of the Medical Students Association from Portugal, ANEM- Portugal, National Member Organization of International Federation of Medical Students Associations. For the past four years, he has been involved in multiple initiatives and discussions in the field of National and International External Affairs, Global Health and Health Workforce.