Mwaka et al.

BMC Medical Education (2022) 22:519

https://doi.org/10.1186/s12909-022-03576-4

RESEARCH Open Access

Patients’ attitudes towards involvement

of medical students in their care at university
teaching hospitals of three public universities
in Uganda: a cross sectional study
Amos Deogratius Mwaka1,2, Seti Taremwa3, Winnie Adoch4, Jennifer Achan4, Peruth Ainembabazi3,
Grace Walego3, Moses Levi Ntayi3, Felix Bongomin2,5 and Charles Benstons Ibingira6*

Abstract
Background: Comfort of patients with medical students is important and promotes appropriate clinical reasoning
and skills development in the students. There is however limited data in this field in Uganda. In this study, we exam-
ined the attitudes and comfort of patients attending care at the medical and obstetrics/gynecology specialties in
teaching hospitals of three public universities in Uganda.
Methods: We conducted a cross sectional study among patients attending care at teaching hospitals for three public
universities; Makerere University (Mak), Mbarara University of Science and Technology (MUST), and Gulu University
(GU). Logistic regression was used to determine the magnitude of associations between independent and dependent
variables. Two-sided p < 0.05 was considered statistically significant.
Results: Eight hundred fifty-five patients participated in the study. Majority were aged 18 — 39 years (54%, n = 460),
female (81%, n = 696) and married (67%, n = 567). Seventy percent (n = 599) of participants could recognize and
differentiate medical students from qualified physicians, and had ever interacted with medical students (65%,
n = 554) during earlier consultations. Regarding attitudes of patients towards presence of medical students during
their consultations, most participants (96%; n = 818) considered involvement of medical students in patients’ care
as essential ingredient of training of future doctors. Most participants prefer that medical students are trained in the
tertiary public hospitals (80%; n = 683) where they attend care. Participants who were single/never married were 68%
less likely to recognize and differentiate medical students (aOR = 0.32, 95%CI: 0.22 — 0.53) from other members of the
healthcare team as compared with married participants. Participants with university education had 55% lower odds of
being comfortable with presence of medical students during consultation compared to those with primary educa-
tion (aOR = 0.45, 95%CI: 0.21 — 0.94). Participants from MUST teaching hospital had twofold higher odds of being
comfortable with presence of medical students compared to participants from Mak teaching hospitals (aOR = 2.01;
95%CI: 1.20 — 3.39).

*Correspondence: cibingira@gmail.com
6
Department of Anatomy, School of Biomedical Sciences, Makerere
University, P.O Box 7072, Kampala, Uganda
Full list of author information is available at the end of the article

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Mwaka et al. BMC Medical Education (2022) 22:519 Page 2 of 16

Conclusion: Patients are generally comfortable with medical students’ involvement in their care; they prefer to seek
care in hospitals where medical students are trained so that the students may contribute to their care. Medical stu-
dents need to introduce themselves appropriately so that all patients can know them as doctors in training; this will
promote patients’ autonomy and informed decisions.
Keywords: Medical students, Patients’ consent, Privacy, Clinical skills, Medical education

Background York et al., most patients would allow medical students

Direct contact with patients play a crucial role in the participate in their future hospital care mainly because
development of clinical reasoning, communication skills, students provided most of the information they needed
and professional attitudes among medical students [1]. for their decisions making and were less in a hurry com-
Student patient interactions at the bedside during teach- pared to the qualified healthcare professionals [10]. The
ing by the physicians remain the cornerstone for the finding that patients based quite a lot of their decisions
proper training of future doctors and the practice of on information got from students is important for the
medicine. Sir William Osler taught doctors that “it is a healthcare professionals during counseling and decision
safe rule to have no teaching without a patient for a text, making especially if students provided inaccurate infor-
and the best teaching is that taught by the patient him- mation upon which decisions are being made by the
self ” [2, 3]. Most patients often allow medical students to patients and their families. A study conducted at vari-
get involved in their care [4, 5]. In the United Kingdom, ous departments in India involving 200 patients showed
a study involving 278 patients attending general practice that majority (83.5%) of patients were comfortable with
surgery consultation with and without a medical stu- the presence of medical students among the hospital
dent present in six general practices in the Oxford area care team. Male patients were more positive and wel-
showed that majority of patients had positive attitudes coming to the students compared to female patients. In
towards involvement of medical students in their care, regard to specialties, patients in the obstetrics and gyne-
irrespective of the sex of the medical student. Only eight cology wards were more likely to reject student involve-
patients (3%) of all respondents demonstrated discomfort ment in hospital procedures [11]. In a study in the United
with presence of medical students during their consulta- Arab Emirates, two hundred sixty-four women (87.1%)
tions and procedures [4]. Similarly, majority of patients accepted student involvement; 158 women (59.8%) pre-
in a study at a genitourinary facility in Leeds, UK, that ferred female students. Comfort levels were significantly
involved 250 male and 250 female patients were comfort- lower with male students in all skills that were tested
able with the involvement of medical students in their particularly pelvic examination and the discussion of sex-
care. Only 13% and 15% of women and men respectively ual problems [12]. Similar findings have been reported
expressed discomfort; most of the patients who declined from Africa. In Tunisia, it was found that higher accept-
were younger women and men, those visiting the clinic ance and comfort with medical students’ involvement
for the first time, and women with no children. They in care was among male patients, patients aged more
were uncomfortable with both male and female medical than 40 years, and those employed compared to women,
students [6]. Similar findings were reported from Aus- patient aged under 40 and unemployed patients [13]. In
tralia where majority of patients were comfortable with Ethiopia, a study involving three hundred and ninety-two
involvement of medical students and recommended stu- inpatients showed that participants were acceptable to
dents be part and parcel of the medical team [7]. Other involvement of medical students in their care. The level
studies have showed that the level of global satisfaction of acceptance varied with the specialty; medical (77.4%),
of patients with their care did not vary between patients surgical (72.0%) and gynecology ward (69.2%), although
who consulted with their physicians alone and those the differences were not statistically significant. Less than
who consulted in the presence of medical students [8, 9]. half (26.8%, n = 150) of patients expressed discomfort
A study in the US among surgical patients showed that with the presence of medical students during their care
patients’ attitudes were favorable regarding participation [14].
of medical students in their care. The year of study or A systematic review involving sixteen studies (1990
experience of the medical students did not significantly to 2010) showed that patients with emotional problems
influence the decisions of the patients to allow medical and those that needed an intimate examination were less
students participate in their care. The patients reported likely to allow involvement of medical students in their
that medical students answered their key questions and care. The patients considered participation of medical
improved their satisfaction with care [10]. In the study by students as important because it is the right thing to do
Mwaka et al. BMC Medical Education (2022) 22:519 Page 3 of 16

as a contribution to the training of the students (altru- medical specialty patients and Kawempe National Refer-
ism), but also because they get more time, a thorough ral hospital for obstetrics – gynecology patients. Medical
physical examination, and receive better patient educa- students in MUST are taught at Mbarara Regional Refer-
tion as the students are being taught [15]. Patients who ral hospital where both medical and obstetrics – gynecol-
decline medical students’ involvement in their care ogy patients receive care. Medical students from Gulu
express concerns with privacy especially during intimate University are taught from St. Mary’s hospital Lacor (Pri-
examinations, inadequate students’ supervision, con- vate Not for Profit) and Gulu Regional Referral hospital.
sultations involving emotional problems, and student We collected data from Gulu Regional Referral hospital
level of training and therefore their perceived skillsets where both medical and obstetrics—gynecology patients
and competence [15, 16]. There are some evidence that receive care. We did not collect data from the private not
women in the obstetrics and gynecology services have for profit hospital to avoid variation in characteristics of
concerns with the skills of medical students in certain the patients due to ability to pay.
procedures including delivery and pelvic examinations.
These concerns in some ways influence their decisions Study design
to accept involvement of medical students in their care This was a cross sectional study that used questionnaire
[16]. Patients who negatively perceive involvement of for data collection.
medical students in their healthcare can provide false
and inappropriate information simply for the fulfillment Study population, sample size and sampling procedure
of the request of the medical students to clerk them [4]. The study population included patients with hyper-
False information from patients regarding symptoms and tension and diabetes attending the medical clinics and
their evolution potentially misleads healthcare profes- wards, and patients with gynaecology disorders attend-
sionals including medical students in the evaluation and ing care at the gynaecology clinics and wards of the
diagnosis of the patients. In a study of 222 women who selected university teaching hospitals. Prospective par-
accepted medical students and 78 who objected to medi- ticipants ought to be aged 18 years and above, of sound
cal students’ involvement in their care, 73% of those who mind, and willing to provide written informed consents.
accepted said they do so to support learning of the stu- Pregnant women were excluded from the study. Sample
dents, while 61% of those who objected raised concerns size was calculated based on the Kish Leslie formula for
with their privacy as the main reasons to refuse medical survey. The proportion of outcome of interest was esti-
students’ participation in their care [17]. mated at 50% since we did not have similar studies from
In Uganda, medical students are trained in the regional, the region. The calculated sample size based on allowable
large private, and national referral hospitals that are error of 5% and a two sided level of significance at 5%, and
meant for the provision of specialized healthcare to the alpha value of 1.96 was 384. We applied a design effect of
populations [18, 19]. However, there is limited data from 2 to account for inter-cluster variation which otherwise
Uganda and sub–Saharan Africa generally on the atti- would lead to erroneous findings. Estimated sample size
tudes and comfort of patients with the presence of medi- was therefore 384 × 2 = 768. An additional 12% (92) was
cal students during their care. These data is important considered for non-response and incomplete data. We
in informing training of medical students, and provision therefore aimed to recruit 860 participants; 287 from
of quality acceptable medical services to patients. In this each of the public university and half (430) from each of
study we aimed to evaluate the perceptions, dispositions medical and obstetrics-gynaecology specialty. We used
and willingness of patients attending gynecology, diabe- systematic random sampling to select participants for the
tes and hypertension clinics and wards regarding involve- study. The number of patients coming into the hospitals
ment of medical students in patients’ care in four selected had reduced during the period of data collection because
public university teaching hospitals in Uganda. of travel restrictions related to the coronavirus 2019
(COVID-19) pandemic. We therefore sampled every
Methods third patient registered on the clinic days for the given
Study setting hospital, and sampled every third patient among the new
This study was conducted at the teaching hospitals for admissions. A list of registered patients was made as the
three public universities; Makerere University (Mak), patients reported to the clinics on the specific clinic days.
Mbarara University of Science and Technology (MUST), The research assistants then selected every third patient
and Gulu University (GU). Makerere University is the on the list for inclusion into the study. The research
oldest of the three universities, followed by MUST then assistants also visited the wards early morning (Mon-
Gulu University. For Makerere University, we collected day to Friday) and made a list of all new patients. They
data from Kiruddu National Referral hospital for the similarly selected every third patient for inclusion into
Mwaka et al. BMC Medical Education (2022) 22:519 Page 4 of 16

the study. The first participant was identified by simple to an excel spreadsheet and reviewed by a biostatistician
random sampling of the first 3 patients. Thereafter, every and GW. After data collection was completed, the bio-
3rd patient on the list was approached for inclusion. If a statistician reviewed data from 12% of randomly selected
selected patient declined, the next patient on the list was participants to ensure data quality. There were no signifi-
considered. Thereafter, the interval of every ­3rd patient cant inconsistencies in the final dataset used for analyses.
was resumed. This process was conducted till the sample
size was achieved for each teaching hospital.
Data analysis
We conducted univariate analysis to describe the demo-
Data collection and management graphic characteristics of participants, and attitudes and
We collected data during June through September dispositions of patients towards presence and involve-
2020 when the Uganda National Council for Sciences ment of medical students in their care. The results were
and Technology (UNCST) allowed research involving reported as frequencies and percentages. Bivariate analy-
patients to restart after a ban was laid in March 2020 sis using Chi square tests were conducted to determine
because of the COVID−19 pandemic. We developed associations between the binary outcome measures
the tool for data collection based on experience and lit- with socio-demographic correlates. Multivariate logistic
erature as well as adapting questions from question- regression models were applied on categorical variables
naires used in earlier studies [5, 20–22]. Questions were with binary outcomes (Yes and No) to determine the
adjusted to make them relevant to the circumstances in magnitudes of associations between the binary outcome
Uganda. For example, questions regarding booking of measures (e.g. questions 112 and 108) with selected inde-
appointments and keeping a given number of minutes for pendent variables. Statistical significance was set at two-
the appointment were removed as they do not apply to sided p < 0.05. Effect measures reported were the odds
healthcare consultations in Uganda where patients walk ratios with their accompanying 95% confidence intervals.
in and meet any healthcare professionals assign to man- Question 112 in the questionnaire was used as the main
age them without necessarily making a specific personal outcome measure; “How do you feel about medical stu-
appointment. We piloted the tool with five patients from dents being present while you are talking to the doctor
each of medical and obstetrics – gynaecology depart- about your problem?”, and the outcome was categorized
ments at the Makerere University teaching hospitals. We as “Yes” and “No”. We also used question 113 as proxy
then reviewed the pilot data and adjusted the study tool and conducted sensitivity analyses using it. Question 113
accordingly before use in the main data collection. The was, “Would you allow medical student(s) to be present
10 patients involved in the pilot phase were not included while you are talking to the doctor about your prob-
in the main study. The final English version of the tool lem?” Question 108 was also used as an outcome meas-
(Additional file 1) was translated into Luo and Luganda ure regarding ability of participants to recognize medical
to help the research assistants communicate the same students and differentiate them from qualified doctors.
thing to participants who did not understand English. No The question was; “When doctors come to see you for the
selected participants declined to participate. problems that have brought you to the hospital, would
Data collection was conducted by experienced gradu- you be able to tell whether some of the doctors are medi-
ate research assistants (RA), two of whom were pursuing cal students?”.
master degrees in Public Health at Makerere University.
The selected Research Assistants (RAs) were trained
Results
for two days on the study tool, objectives of the study,
Characteristics of the participants
and consenting procedures; they were also provided
We enrolled a total of 855 study participants (99.4%
a brief background on issues regarding patient doc-
response rate). Majority of participants were aged 18 –
tor relationships and how the interactions can influence
39 years (53.8%; n = 460), female (81.4%; n = 696), and
health−seeking including delay and advanced disease at
married (66.6%; n = 567). More than half (62.9%; n = 533)
diagnoses. These were to ensure quality data were col-
of participants had formal employment (Table 1).
lected. ST and FB supervised the research assistants dur-
ing data collection. The RA collected data using android
phones loaded with the Open Data Kit (ODK) software. Patients’ attitudes towards presence of medical
Each RA interviewed patients independently. There students during consultations
were eight RAs: two (both female) in Gulu University, Most participants (70.1%; n = 599) could recognize and
four (two female) in Makerere University, and two (one differentiate medical students from qualified physicians,
female) in Mbarara University of Science and Technol- and more than half (64.8%, n = 554) had ever had medical
ogy. Data from the ODK system of each RA was uploaded students present during earlier consultations. Regarding
Mwaka et al. BMC Medical Education (2022) 22:519 Page 5 of 16

Table 1 Socio-demographic characteristics of participants eager/very eager with medical students during their con-
Characteristics Frequency Percentage (%)
sultations (Table 2).
The main considerations patients make in deciding
Age (Years), N = 855 whether or not medical students be involved in their care
  18–39 years 460 53.8 included perceived severity of illness (55.2%; n = 472) and
  40–59 years 291 34.0 sex (78.4%; n = 670) of the medical students. However,
   ≥ 60 104 12.2 patients did not take into account prior experience with
  Missing 0 0 medical students (64.8%; n = 554), duration of consulta-
  Median age: 38, IQR: 28 – 50 tion (70%; n = 598) and their own religious beliefs (91.5%;
  Mean age: 40.2, SD:14.7
n = 782) (Table 2).
Sex of participant, N = 855
  Male 159 18.6
Perceived importance of involving medical students
  Female 696 81.4
in patients’ care
Marital status, N = 855
Most participants (95.7%; n = 818) considered involve-
  Married/Cohabiting 567 66.6
ment of medical students in patients’ care as an essential
  Single/Never married 93 10.9
(very important and important) ingredient of training of
  Separated/Divorced 96 11.3
future doctors. The majority of the participants would
  Widowed/Widower 95 11.2
even prefer that medical students are trained in the pub-
  Missing 4
lic hospitals where they go for care (79.9%; n = 683) as
Education Attainment, N = 842
opposed to the minority (23.7%; n = 203) who would pre-
  Primary 327 38.8
fer students to be trained in separate designated univer-
  Secondary 281 33.4
sity teaching hospitals (Table 3).
  Tertiary 97 11.5
  University 46 5.5
Ability of patients to recognize medical students
  No formal education 91 10.8
Upon adjusting for age, sex, educational attainment and
  Missing 13
employment status, participants who were single/never
Religion, N = 855
married were 68% less likely to recognize and differentiate
  Catholic 328 38.5
medical students (AOR = 0.32, 95%CI: 0.22 – 0.53) from
  Anglican 289 33.9
other members of the healthcare team as compared with
  Islam 98 11.5
the married participants. On adjusting for the same socio-
  Pentecostal/Born again 128 16.0
demographic factors above, participants from the newest
  Others 9 1.1
of the three universities (Gulu University teaching hospi-
  Missing 3
tal) were two and half times more likely to recognize and
Employment, N = 848
differentiate medical students from other members of the
  No formal employment 315 37.2
healthcare team (AOR = 2.51, 95%CI: 1.65 – 3.80) as com-
  Formal employment 533 62.8
pared to participants from Makerere University (Table 4).
  Missing 7
University teaching hospital
Factors associated with patients’ dispositions
  Makerere University (Mak) 281 32.9
towards presence of medical students
  Mbarara University of Science 286 33.5
and Technology (MUST) The majority of participants (82.3%; n = 704) were com-
  Gulu University (GU) 288 33.7 fortable with medical students’ presence during their
Specialty Clinic consultations. After adjusting for age, sex, marital status,
  Diabetic Clinic 382 44.7 and employment, participants with university education
  Medicine Ward 58 6.8 had 55% less odds of being comfortable with presence of
  Gynecology clinic 172 20.1 medical students during consultation compared to those
  Gynecology ward 243 28.4 with primary education (adjusted odds ratio (aOR = 0.45,
95%CI: 0.21 — 0.94). On adjusting for age, sex, marital
status, educational and employment status, participants
from MUST teaching hospital had twofold higher odds
attitudes of patients towards presence of medical stu- of being comfortable with presence of medical students
dents during their consultations, more than half (68.5%; compared to participants from Makerere university teach-
n = 586) would not mind, while 13.8% (n = 118) would be ing hospitals (aOR = 2.01; 95%CI: 1.20 — 3.39). However,
age, sex, marital status and employment status were not
Mwaka et al. BMC Medical Education (2022) 22:519 Page 6 of 16

Table 2 Attitudes towards presence of medical students during clinical encounters

Domains assessed Frequency Percentage (%)

Participant can differentiate medical students from doctors

  No 189 22.1
  Yes 599 70.1
  Not sure 63 7.4
  Missing 4
Participant has ever had medical students present during consultation with their doctors
  No 188 22.0
  Yes 554 64.8
  Not sure 113 13.2
Feelings towards presence of medical students when patient is talking to the physician/doctor about his/her health
problems
  Extremely uneasy 67 7.8
  Uneasy 84 9.8
  Don’t mind 586 68.5
  Eager 64 7.5
  Very eager 54 6.3
Allowable extent of participation of medical students in patient care
  Medical history taking only 59 10.7
  History taking and physical examinations 121 21.8
  History taking, physical examinations and procedures 338 61.0
  Observe physician/ doctor as she/he does her/his work of care 36 6.5
  Will never allow medical students during my care
Circumstances under which participant would allow medical students to participate in his/her care
  When she/he is requested by her nurse 74 13.4
  When she/he is requested by her physician/doctor 223 40.3
  When she/he is requested by her clinical/medical assistant 95 17.2
  Will never allow medical students during my care 162 29.2
Considerations made regarding involvement of medical students in patient care
Patients’ cultural beliefs
  No 786 91.9
  Yes 69 8.1
Patients’ religious beliefs
  No 782 91.5
Yes 73 8.5
Consultations take longer when medical students are present
  No 598 70.0
  Yes 257 30.1
Patients’ personality
  No 453 53.0
  Yes 402 47.0
When patients condition is not too serious/bad
  No 383 44.8
  Yes 472 55.2
Prior experiences with medical students
  No 554 64.8
  Yes 301 35.2
Sex of medical student
  No 185 21.6
  Yes 670 78.4
Quality of care may be affected
  No 595 69.6
  Yes 260 30.4
Mwaka et al. BMC Medical Education (2022) 22:519 Page 7 of 16

Table 3 Perceived importance of involving medical students in patients’ care

Domain assessed Frequency Percentage

How important is it for the training for future doctors, that medical students are present when patients are talking
to their doctors/physicians about their problems?
  Very important 682 79.8
  Important 136 15.9
  Not sure 27 3.2
  Not important 8 0.9
  Unnecessary 2 0.2
How important is it for the training of future doctors that medical students examine patients
  Very important 666 77.9
  Important 149 17.4
  Not sure 29 3.4
  Not important 7 0.8
  Unnecessary 4 0.5
Is it preferable that medical students are trained in designated teaching hospitals separate from public hospitals
  Most preferred 124 14.5
  A lot preferred 79 9.2
  Somewhat preferred 165 19.3
  Not quite preferred 163 19.1
  Not preferred at all 324 37.9
Is it preferable that medical students are trained in the public hospitals including national and regional referral
hospitals?
  Most preferred 594 69.5
  A lot preferred 89 10.4
  Somewhat preferred 83 9.7
  Not quite preferred 39 4.6
  Not preferred at all 50 5.9

significantly associated with patients’ comfort with the with their preference as to where medical students should be
presence of medical students during clinical consultations trained in separate designated university teaching hospitals or
(Table 5). in the tertiary public hospitals as it is the case currently. Upon
adjusting for the socio-demographic factors, participants
Influence of specialty on patient’s comfort from MUST had 63% less odds of preferring medial students
with the presence of medical students during consultation to be trained in designated and separate university teaching
On adjusting for age, sex, marital status, education and hospitals (AOR = 0.27, 95%CI: 0.17 — 0.44) as compared to
employment status, patients from the medical depart- the participants from Makerere University (Table 8). How-
ments of MUST had nearly threefold higher odds of ever, when asked as to whether medical students be trained
being comfortable with the presence of medical students in the tertiary public hospitals as opposed to separate uni-
during consultations (aOR = 2.83, 95%CI: 1.24 – 6.49) versity teaching hospitals, most participants (79.9%; n = 683)
compared to those from Makerere university teaching answered to the affirmative. On adjusting for the socio-demo-
hospitals. However, no socio-demographic factors were graphic factors, participants from both GU and MUST teach-
associated with patients’ comfort with the presence ing hospitals had 2 – 8 folds higher odds (AOR = 2.27 – 8.14,
of medical students among the gynecology patients in 95%CI: 1.50 – 14.50) compared to those from Mak teaching
both MUST and GU teaching hospitals as compared to hospitals to prefer training of medical students to be done in
patients from Mak teaching hospital (Table 6 and 7). the tertiary public hospitals (Table 9).

Patients’ preferred hospitals for training of medical Discussions

students We present insights from sub Saharan Africa regard-
Age, sex, marital status, educational attainment and employ- ing patients’ attitudes towards and comfort with medi-
ment status of participants were not significantly associated cal students during clinical consultations and care. In
Mwaka et al. BMC Medical Education (2022) 22:519 Page 8 of 16

Table 4 Factors associated with patients’ recognition of medical students

Recognizes medical students Crude Odds ratio Adjusted Odds ratio (95%CI)a
Characteristics Yes No
N (%) N (%)

Age of participants (Years)

  18 – 39 310 (51.8) 147 (58.3) 1.00 1.00
  40 – 59 218 (36.4) 72 (28.6) 1.44 (1.03—2.00) 1.19 (0.80—1.76)
  ≥ 60 71 (11.9) 33 (13.1) 1.02 (0.65—1.61) 1.01 (0.57—1.8)
Sex of participant
  Male 121 (20.2) 38 (15.1) 1.00 1.00
  Female 478 (79.8) 214 (84.9) 0.70 (0.47—1.05) 1.04(0.64—1.71)
Marital status
  Married/cohabiting 416 (69.7) 147 (58.8) 1.00 1.00
  Single/never married 47 (7.9) 46 (18.4) 0.36 (0.23—0.56) 0.32 (0.2—0.53)
  Separated/divorced 63 (10.6) 33 (13.2) 0.67 (0.42—1.07) 0.86 (0.53—1.40)
  Widowed/widower 71 (11.9) 24 (9.6) 1.05 (0.63—1.72) 1.71 (0.93—3.15)
Education attainment
  Primary education 215 (36.5) 111 (44.4) 1.00 1.00
  No formal education 53 (9.0) 37 (14.8) 0.74 (0.46- 1.19) 0.67 (0.40—1.13)
  Secondary education 206 (35.0) 74 (29.6) 1.44 (1.01—2.04) 1.87 (1.28—2.74)
  Tertiary education 76 (12.9) 21 (8.4) 1.86 (1.09—3.20) 2.32 (1.30—4.12)
  University 39 (6.6) 7 (2.8) 2.88 (1.24—6.69) 4.15 (1.68—10.23)
Employment status
  No formal employment 191 (32.1) 123 (49.2) 1.00 1.00
  Formal employment 405 (68.0) 127 (50.8) 2.05 (1.51—2.79) 1.79 (1.30—2.49)
University hospital
  Makerere University 164 (27.4) 114 (45.2) 1.00 1.00
  Mbarara University (MUST) 203 (33.9) 83 (32.9) 1.70 (1.19—2.41) 1.30 (0.88—1.93)
  Gulu University 232 (38.7) 55 (21.8) 2.93 (1.98—4.33) 2.51 (1.67—3.80)
Specialty
  Gynecology 274 (45.7) 138 (54.8) 1.00 1.00
  Medical 325 (54.3) 114 (45.2) 1.44 (1.07—1.93) 1.36 (0.900—2.05)
MUST  Mbarara University of Science and Technology
a
Adjusted for all factors on table
Bold Factors statistically significant

our knowledge, this is the first study from Uganda since equivalent level hospitals where students are not. The
the inception of the first medical school at Makerere sex of the medical student was not an important con-
University in 1923 that has assessed patients’ comfort sideration in deciding whether or not a medical student
with the involvement of medical students in their care should be involved in a patient’s care. The patients’ level
in three university teaching hospitals. We found that of comfort with medical students did not significantly
most patients could recognize and differentiate medi- vary between patients attending care at the medical and
cal students from doctors. Majority of the participants obstetrics-gynecology departments. Highly educated
had had previous experiences with medical students, patients from the medical department were less likely
and do not mind the involvement of medical students to be comfortable with the involvement of medical
in their care nor are they bothered with the increased students in their care. The few participants who were
consultation time because the physicians are teach- uncomfortable with involvement of medical students
ing medical students during consultations. Partici- in patients’ care were concern with invasion of pri-
pants prefer to attend care in the university teaching vacy by the unqualified medical students. The patients
hospitals where medical students are trained than in from Makerere University teaching hospitals situated
Mwaka et al. BMC Medical Education (2022) 22:519 Page 9 of 16

Table 5 Factors associated with comfort of patients with presence of medical students during consultations
Feels comfortable Crude Odds ratio (95%CI) Adjusted Odds
ratio (95%CI)a
Characteristics Yes, N (%) No, N (%)

Age of participants (Years)

  18 – 39 364 (51.7) 96 (63.6) 1.00 1.00
  40 – 59 249 (35.4) 42 (27.8) 1.56 (1.05—2.33) 1.46 (0.92—2.30)
   ≥ 60 91 (12.9) 13 (8.6) 1.85 (0.99- 3.45) 1.89 (0.91—3.95)
Sex of participant
  Male 133 (18.9) 26 (17.2) 1.00 1.00
  Female 571 (81.1) 125 (82.8) 0.89 (0.56—1.42) 1.08 (0.64—1.80)
Marital status
  Married/cohabiting 463 (66.1) 104 (68.9) 1.00 1.00
  Single/never married 74 (10.6) 19 (12.6) 0.87 (0.51—1.51) 1.09 (0.61—1.96)
  Separated/divorced 81 (11.6) 15 (9.9) 1.21 (0.67—2.19) 1.15 (0.63—2.1)
  Widowed/widower 82 (11.7) 13 (8.6) 1.42 (0.76—2.64) 1.05 (0.51—2.16)
Education attainment
  Primary education 280 (40.4) 47 (31.7) 1.00 1.00
  Secondary education 221 (31.9) 60 (40.3) 0.62 (0.41—0.94) 0.69 (0.45—1.07)
  Tertiary education 84 (12.1) 13 (8.7) 1.08 (0.56—2.10) 1.11 (0.57 -2.16)
  University 33 (4.8) 13 (8.7) 0.43 (0.42—1.47) 0.45 (0.21- 0.94)
  No formal education 75 (10.8) 16 (10.7) 0.789 (0.42—1.47) 0.69 (0.36—1.32)
Employment status
  No formal employment 257 (36.9) 58 (38.4) 1.00 1.00
  Formal employment 440 (62.85) 93 (61.6) 1.07 (0.74—1.53) 1.08 (0.74—1.58)
University hospital
  Makerere University 229 (32.5) 52 (34.4) 1.00 1.00
  Mbarara University (MUST) 256 (36.4) 30 (19.9) 1.94(1.19–3.15) 2.01(1.20—3.39)
  Gulu University 219 (31.1) 69 (45.7) 0.72(0.48–1.08) 0.71 (0.46 -1.09)
Specialty
  Gynecology 334 (47.4) 81 (53.6) 1.00 1.00
  Medical 370 (52.6) 70 (46.4) 1.28 (0.900—1.82) 1.04 (0.65—1.67)
MUST Mbarara University of Science and Technology
a
Adjusted for all factors on table
Bold Factors statistically significant

in the capital city were significantly more likely to be comfortable with involvement of medical students in
uncomfortable with involvement of medical students in patient care. While it could be expected that older patients
patients’ care. would be uncomfortable with involvement of medical stu-
In this study, majority of participants were young (aged dents (most are young) in their care, our data do not show
less than 40 years), female, married and with some formal that. Earlier studies showed that both outpatients and
employments. The age distribution of participants in this older hospitalized patients have positive attitudes towards
study is similar to other studies in this field of research. medical students’ involvement in their care [24]. Although
For example, a study in Canada that involved 625 patients more context specific data are needed, our finding that
from various specialties had a mean age of 39 years, with age of patients does not determine patients’ comfort and
the majority aged 30 – 65 years. Majority of the patients acceptance of medical students’ involvement in patient
(62%) in that study were female [23]. In the US, a study in care means that the deployment of medical students shall
the Midwest involving 213 obstetric gynecology patients therefore not be restricted by the age of the patients.
had a mean age of 34.9 years [20]. In this study, age of Most participants in this study were able to recognize
participants was not statistically associated with being and differentiate medical students from the qualified
Mwaka et al. BMC Medical Education (2022) 22:519 Page 10 of 16

Table 6 Factors associated with comfort of patients in the medical specialty with the presence of medical students during
consultations
Feels comfortable Crude Odds ratio (95%CI) Adjusted Odds ratio (95%CI)a
Characteristics Yes No
N (%) N (%)

Age of participants (Years)

  18—39 89 (24.1) 25 (53.7) 1.00 1.00
  40—59 199 (53.8) 34 (48.6) 1.64 (0.93—2.92) 1.30 (0.68—2.50)
   ≥ 60 82 (22.2) 11 (15.7) 2.09 (0.97—5.52) 1.86 (0.77—4.48)
Sex of participant
  Male 133 (36.0) 26 (37.1) 1.00 1.00
  Female 237 (64.1) 44 (62.9) 1.05 (0.62—1.79) 1.05 (0.59—1.89)
Marital status
  Married/cohabiting 238 (64.3) 47 (67.1) 1.00 1.00
  Single/never married 27 (7.3) 8 (11.4) 0.67 (0.29—1.56) 0.92 (0.36—2.39)
  Separated/divorced 39 (10.5) 8 (11.4) 0.96 (0.42—2.19) 0.86 (0.36—2.06)
  Widowed/widower 66 (17.8) 7 (10.0) 1.86 (0.80—4.31) 1.7 (0.67—4.30)
Education attainment
  Primary education 152 (41.6) 22 (31.8) 1.00 1.00
  Secondary education 101 (27.7) 22 (31.9) 0.66 (0.35—1.26) 0.79 (0.4—1.58)
  Tertiary education 46 (12.6) 8 (11.6) 0.83 (0.35—1.99) 0.90 (0.36—2.22)
  University 18 (4.9) 7 (10.1) 0.37 (0.14—0.99) 0.38 (0.133—1.07)
  No formal education 48 (13.2) 10 (14.5) 0.69 (0.31—1.57) 0.62 (0.26—1.46)
Employment status
  No formal employment 116(31.7) 28(40.0) 1.00 1.00
  Formal employment 250(68.3) 42(60.0) 1.43 (0.85–2.43) 1.62 (0.92–2.87)
University hospital
  Makerere University 114 (30.8) 25 (35.7) 1.00 1.00
  Mbarara University (MUST) 137 (37.0) 11 (15.7) 2.73 (1.29—5.79) 2.83 (1.24—6.49)
  Gulu University 119 (32.2) 34 (48.6) 0.77 (0.43—1.37) 0.80 (0.42—1.51)
MUST Mbarara University of Science and Technology
a
Adjusted for all factors on table
Bold Factors statistically significant

medical doctors. Majority of them had ever had medi- involved in their care. The patients should consciously
cal students present in their previous consultations consent to involvement of medical students in their care.
and healthcare. The participants who were married, They should as well be told the roles of medical students
with higher educational attainment and those formally in their care.
employed were more likely to recognize medical stu- The majority of participants were comfortable with
dents. Our finding coheres with most studies in which involvement of medical students in their care. They
majority of patients recognize medical students. How- did not feel that presence of medical students would
ever, results from a few studies show that a varying adversely affect the quality of care, nor were they con-
proportion of patients don’t know how to differentiate cern with the longer duration of consultation when medi-
qualified healthcare professionals from medical students cal students are present. This positive finding regarding
[10, 13]. For example, in Tunisia, up to 78% of patients did acceptance of medical students by patients in univer-
not realize that medical students were involved in their sity teaching hospitals is quite encouraging. Our find-
care [13]. In Australia, a study among women attending ing is similar to results from other studies from both
antenatal care reported that more than half of the women the high-income countries (HIC) and low- and -middle
(54%; N = 625) had challenges differentiating medical income countries (LMIC) where patients across special-
students from other health professionals cadres [25]. It is ties have shown acceptance for medical and other health-
important that patients are told that medical students are care students to be involved in patients’ care as part of
Mwaka et al. BMC Medical Education (2022) 22:519 Page 11 of 16

Table 7 Factors associated with comfort of patients in the gynecology specialty with the presence of medical students during
consultations
Feels comfortable Crude Odds ratio (95%CI) Adjusted Odds
ratio (95%CI)a
Characteristics Yes No
N (%) N (%)

Age of participants (Years)

  18 – 39 275 (82.3) 71 (87.7) 1.00 1.00
  40 – 59 50 (15.0) 8 (9.9) 1.61 (0.73—3.56) 1.73 (0.69—4.35)
   ≥ 60 9 (2.7) 2 (2.5) 1.16(0.25–5.5) 2.51 (0.35—17.87)
Sex of participant
  Female 334 81 - -
  Male - - - -
Marital status
  Married/cohabiting 225 (68.2) 57 (70.4) 1.00 1.00
  Single/never married 47 (14.2) 11 (13.6) 1.08 (0.53—2.22) 1.11 (0.51—2.46)
  Separated/divorced 42 (12.7) 7 (8.6) 1.52 (065—3.56) 1.31 (0.44 -3.15)
  Widowed/widower 16 (4.9) 6 (7.4) 0.68 (0.25—1.80) 0.30 (0.78—1.18)
Education attainment
  Primary education 128 (39.0) 25 (31.3) 1.00 1.00
  Secondary education 120 (36.6) 38 (47.5) 0.62 (0.35—1.08) 0.6 (0.33—1.07)
  Tertiary education 38 (11.6) 5 (6.3) 1.48 (0.53—4.14) 1.44 (0.500—4.14)
  University 15 (4.6) 6 (7.5) 0.49 (0.17—1.38) 0.46 (0.15—1.40)
  No formal education 27 (8.1) 6 (7.5) 0.88 (0.33—2.35) 0.87 (0.29—2.61)
Employment status
  No formal employment 141 (42.6) 30 (37.0) 1.00 1.00
  Formal employment 190 (57.4) 51 (63.0) 0.79 (0.48—1.31) 0.81 (0.48—1.38)
University hospital
  Makerere University 115 (34.4) 27 (33.3) 1.00 1.00
  Mbarara University (MUST) 119 (35.6) 19 (23.5) 1.47 (0.78—2.79) 1.64 (0.81—3.3)
  Gulu University 100 (30.0) 35 (43.2) 0.67 (0.38—1.19) 0.68 (0.37—1.26)
MUST Mbarara University of Science and Technology
a
Adjusted for all factors on table

the students’ training. Data from the high-income coun- rectal exams, vaginal deliveries and episiotomy repairs,
tries show that medical students are highly accepted (55 and pelvic examinations [13, 30]. Patients accept medi-
to 95% acceptance) in accident and emergency services cal students to participate in their care because they want
but not as much among pregnant women, especially to contribute to the learning of the students and mak-
during intrapartum care [26–29]. Similarly, data from ing of future doctors, companionship, and because they
the LMIC also show high level of acceptance of medi- learn quite significantly about their own health states
cal students’ involvement in patients’ care. For example, from the medical students who often give significant
in Ethiopia, 69.2% – 77.4% accepted medical students to time to patients. Patients also feel that they learn more
participate in their care [13, 14]. High level of acceptance when the doctors are teaching medical students during
have been also reported from the Middle East; for exam- consultations [16, 20, 23, 25, 28, 31]. Majority of patients
ple, in a study involving patients from various special- concur that patients-medical students’ interactions is
ties in Saudi Arabia, patients were generally acceptable a critical factor in training of competent future doctors
to students’ involvement in their care. Refusal rate was [23]. Participation of medical students in patients’ care
only 11% – 43%, mainly in the obstetrics—gynecology was considered a worthwhile learning experience for the
specialty [30]. Acceptance of medical students is higher students [29]. Similar findings were reported from Aus-
for non-invasive contacts including reading patients’ tralia, where 96% of patients (N = 248) acknowledged the
files, observing doctors during ward rounds, and taking importance of students’ involvement in patients’ care as
history than with intimate procedures including digital part of their training [7]. Patients’ contact under different
Mwaka et al. BMC Medical Education (2022) 22:519 Page 12 of 16

Table 8 Factors associated with patients’ disposition as to whether medical students be trained in the tertiary public hospitals
University teaching hospitals to be Crude Odds ratio (95%CI) Adjusted Odds
autonomous ratio (95%CI)a
Characteristics Yes No
N (%) N (%)

Age of participants (Years)

  18 – 39 113 (55.7) 347 (53.2) 1.00 1.00
  40 – 59 64 (31.5) 227 (34.8) 0.87 (0.61—1.22) 0.82 (0.54—1.23)
   ≥ 60 26 (12.8) 78 (12.0) 1.02 (0.63—1.67) 0.99 (0.5 5- 1.81)
Sex of participant
  Male 42 (20.7) 117 (17.9) 1.00 1.00
  Female 161 (79.3) 535 (82.1) 0.84 (0.57—1.24) 0.85 (0.54—1.23)
Marital status
  Married/cohabiting 140 (69.3) 427 (65.8) 1.00 1.00
  Single/never married 23 (11.39) 70 (10.8) 1.00 (0.60—1.67) 0.85 (0.49- 1.47)
  Separated/divorced 18 (8.9) 78 (12.0) 0.70 (0.41—1.22) 0.77 (0.44—1.34)
  Widowed/widower 21 (10.4) 74 (11.4) 0.86 (0.51—1.46) 1.05 (0.57—1.93)
Education attainment
  Primary education 76 (38.2) 251 (39.0) 1.00 1.00
  Secondary education 67 (33.7) 214 (33.3) 1.03 (0.71—1.51) 0.99 (0.67—1.46)
  Tertiary education 24 (12.1) 73 (11.4) 1.09 (0.64—1.84) 1.10 (0.64—1.89)
  University 16 (8.0) 30 (4.7) 1.76 (0.91—3.42) 1.75 (0.88—3.49)
  No formal education 16 (10.8) 75 (11.7) 0.70 (0.39—1.28) 0.7 (0.64—1.89)
Employment status
  No formal employment 78 (38.8) 237 (36.6) 1.00 1.00
  Formal employment 123 (61.2) 410 (63.4) 0.91 (0.66–1.26) 0.88 (0.62—1.24)
University hospital
  Makerere University 83 (40.9) 198 (30.37) 1.00 1.00
  Mbarara University (MUST) 33 (16.3) 253 (38.8) 0.31 (0.19—0.49) 0.27 (0.17—0.44)
  Gulu University 87 (42.9) 201 (30.8) 1.03 (0.72—1.48) 0.99 (0.67—1.46)
Specialty
  Gynecology 96 (47.3) 319 (48.9) 1.00 1.00
  Medical 107 (52.7) 333 (51.1) 1.07 (0.78—1.47) 1.15 (0.74—1.76)
MUST Mbarara University of Science and Technology
a
Adjusted for all factors on table
Bold Factors statistically significant

clinic settings is an invaluable and inseparable compo- from that of a study from Tunisia, where it was found
nent of appropriate medical training to groom competent that higher acceptance and comfort with medical stu-
medical doctors and other healthcare professionals’ per- dents’ involvement in care was among male patients,
sonnel. The patient-medical student interactions during patients aged more than 40 years, and those employed
training provides a firm irreplaceable platform for the compared to women, patient aged under 40 and unem-
development of clinical skills, patient-physicians commu- ployed patients [13]. Our findings also differs from that
nications, and ethical skills necessary for their practices of Hartz et al. [20] which showed that patients’ education
in the future. level did not influenced their decisions to allow involve-
We found that participants with higher education ment of medical students in their care in general. How-
standards were less comfortable with involvement of ever, they reported that level of education significantly
medical students in their care. However, demographic influenced acceptance and comfort level with medical
characteristics of participants including age, sex, marital students during intimate examinations including pel-
and employment status were not significantly associated vic examinations and performance of Pap smear among
with attitudes and comfort with involvement of medi- women. Women with higher education achievement are
cal students in patients’ care. Our findings are different more willing to accept medical students’ involvement
Mwaka et al. BMC Medical Education (2022) 22:519 Page 13 of 16

Table 9 Medical students to be trained in the regional and national referral hospitals
Regional and national referral hospitals Crude Odds ratio (95%CI) Adjusted Odds ratio (95%CI)a
to be used for training
Characteristics Yes preferred Not preferred
N (%) N (%)

Age of participants (Years)

  18 – 39 374 (54.8) 86 (50.0) 1.00 1.00
  40 – 59 227 (33.2) 64 (37.2) 0.82 (0.57—1.17) 0.81 (0.53—1.25)
   ≥ 60 82 (12.0) 22(12.8) 0.86 (0.51—1.45) 1.03 (0.54—1.96)
Sex of participant
  Male 128 (18.7) 31 (18.0) 1.00 1.00
  Female 555 (81.3) 141 (82.0) 0.95 (0.62—1.47) 1.10 (0.67—1.80)
Marital status
  Married/cohabiting 461 (67.7) 106 (62.4) 1.00 1.00
  Single/never married 75 (11.0) 18 (10.6) 0.96 (0.55—1.67) 1.02 (0.56—1.86)
  Separated/divorced 75 (11.0) 21 (12.4) 0.82 (0.48—1.39) 0.77 (0.45—1.33)
  Widowed/widower 70 (10.3) 25 (14.7) 0.64 (0.39—1.07) 0.63 (0.34—1.14)
Education attainment
  Primary education 265 (39.4) 62 (36.5) 1.00 1.00
  Secondary education 220 (32.7) 61 (35.9) 0.84 (0.57—1.25) 0.81 (0.53—1.23)
  Tertiary education 78 (11.6) 19 (11.2) 0.96 (0.54—1.70) 0.93 (0.51—1.7)
  University 39 (5.8) 7 (4.1) 1.30 (0.56—3.06) 1.06 (0.44—2.56)
  No formal education 70 (10.4) 21 (12.4) 0.78 (0.44—1.37) 0.99 (0.54—1.81)
Employment status
  No formal employment 235 (34.6) 80 (47.6) 1.00 1.00
  Formal employment 445 (65.4) 88 (52.4) 1.72 (1.22—2.43) 1.69 (1.18—2.42)
University hospital
  Makerere University 184 (26.9) 97 (56.4) 1.00 1.00
  Mbarara University   (MUST) 268 (39.2) 18 (10.5) 7.85 (4.42—13.93) 8.14 (4.5 7—14.50)
  Gulu University 231 (33.8) 57 (33.1) 2.14 (1.45—3.14) 2.27 (1.5—3.44)
Specialty
  Gynecology 328 (48.0) 87 (50.6) 1.00 1.00
  Medical 355 (52.0) 85 (49.4) 1.11 (0.79—1.55) 1.38 (0.87—2.19)
MUST Mbarara University of Science and Technology
a
Adjusted for all factors on table
Bold Factors statistically significant

than the less educated women [20]. Our findings also of acceptance and comfort with medical students except
differ from results of a study in Australia, which showed for education attainment. Passaperuma et al. [23] also
that obstetrics and gynecology patients (n = 255) aged found no inter-specialty differences regarding patients’
less than 40 years, and those who were inpatients were comfort and acceptance of medical students’ involve-
significantly more likely to be satisfied with involvement ment in their care. However a large study involving
of medical students in their care. Satisfaction was higher 932 participants from 14 teaching hospitals in Kuwait
among patients seen by female medical students (86%) showed significant inter-specialty difference in accept-
compared with male students (74%) [7]. Majority of med- ance of medical students’ involvement in patients’ care.
ical students maybe young. In our study, majority of our While acceptance was highest in the pediatrics specialty,
patients were also young, with median age 38 years (54% refusal was highest in the obstetrics gynecology specialty
younger than 40 years). This could explain why age did [32]. We recommend more studies in sub Saharan Africa
not feature as a significant factor in determining patients’ across various specialties to shine more light on the
comfort with medical students’ involvement. There was effects of subspecialties and patients’ comfort with medi-
no significant difference by specialty regarding the level cal studies.
Mwaka et al. BMC Medical Education (2022) 22:519 Page 14 of 16

In this study, majority of participants said they which previous students’ involvement influence future
would put into considerations the sex of the medical acceptance and comfort with medical students.
student (78%) and the seriousness of the disease at the Our participants preferred to attend care where medi-
time of consultation. They would not decide based cal students are involved; they would not want the medi-
on their own religious and cultural beliefs, nor length cal students to be trained in separate university teaching
of time of consultations. Majority of the participants hospitals different from the tertiary public hospitals
also said they would not be influenced by the qual- where patients seek care. Our finding is similar to the
ity of their previous experiences with medical stu- study by Passaperuma et al. where they showed that
dents. These findings make it easy to deploy medical majority of patients preferred teaching hospitals to non-
students to interact with patients without the need to teaching hospitals [23]. Medical students’ training could
first sort patients on the basis of certain characteris- continue in the large public hospitals. If some universities
tics. Regarding sex of the students, it is important for start separate designated university teaching hospitals,
medical educators and attending physicians to explain they should keep their gates open to patients who may
to the patients beforehand the need for both male and want to attend care where medical students are trained.
female medical students gaining the required skills. The fees in such university teaching hospitals should be
Our findings on sex of students, previous experiences subsidized to avoid discriminations against the finan-
with medical students and consultation time is similar cially less privileged patients who may want to attend
to results from other studies. For example, York et al. care in university teaching hospitals.
found no significant differences between attitudes of
patients who had previous experiences with medical
students and those who had not [10]. Limitations
Participants from the oldest university teaching hos- This study has some limitations inherent in the design. This
pitals located in the capital city were less likely to be was a cross sectional study; we can only appreciate asso-
comfortable with medical students when compared ciations between the socio-demographic and health sys-
with participants from teaching hospitals of the other tems’ factors with patients’ acceptance without asserting
two universities which are younger and located away causality. Second, our results could be influenced by social
from the capital city. It is not clear why acceptance of desirability bias because data collection was conducted in
students were relatively lower in Makerere University the hospital setting and patients could have responded in
teaching hospitals. Findings from other studies show a manner that would be socially desirable. We minimized
that previous positive students-patients interactions this bias by not involving doctors and or medical students
and experience tend to increase acceptance of medi- in the data collection process. Data were collected by
cal students in future consultations [10]. On the other masters of public health students and graduate research
hand, negative previous experiences tend to reduce assistants who explained to the patients their status and
chance of the patients accepting participation of medi- encouraged them to provide appropriate responses without
cal students in their care [33]. Although Makerere Uni- fear of any retributions. Thirdly, the tool used for data col-
versity medical school started way back in 1923, there lection did not undergo psychometric testing to assess its
is limited data on perceptions of patients on the man- validity and reliability. We also did not conduct exploratory
ner in which students interact with them. The attitude factor analysis to provide insights into underlying psycho-
of patients at Makerere University teaching hospitals logical explanations for observed associations. However, we
could relate more to the location in the capital city believe that the tool measured what we set out to evaluated
center and the cosmopolitan nature of the population because we adapted questions from previously validated
than an intrinsic factor within the university teaching questionnaires and piloted the tool in our local environ-
hospitals themselves. Future studies need to catego- ment. We then fine-tuned the questions based on the find-
rize the patients based on their frequency of previous ings from the pilot study, ensuring that the questions seek
contacts with medical students in order to delineate what they were designed to measure.
the influence of the quality of previous interactions on
current perception of comfort with medical students’ Conclusions
involvement in patients’ care. In the US, patients who Patients are generally comfortable with medical students’
had had fewer contacts with medical students during involvement in their care; and indeed prefer to seek care
their care were more likely to decline medical students’ in university teaching hospitals where medical students
participation in their care [20]. In addition, qualitative contribute to their care. In addition, clinical teachers in
studies exploring perceived quality of care in previous university teaching hospitals need to provide patients
student involvement in care may elucidate the way in with some protected time in the absence of medical
Mwaka et al. BMC Medical Education (2022) 22:519 Page 15 of 16

students so that matters that could not be addressed in Consent for publication
Not applicable.
the presence of medical students do come out. There is
also need for disseminating clear messages to the pub- Competing interests
lic regarding the presence and roles of medical students The authors declare that they have no competing interests.
in the university teaching hospitals so that people who Author details
come their know in advance and make deliberate choices 1
Department of Medicine, School of Medicine, College of Health Sciences,
to come there and knowingly accept or decline participa- Makerere University, Kampala, Uganda. 2 Department of Medicine, Faculty
of Medicine, Gulu University, Gulu, Uganda. 3 School of Medicine, College
tion of medical students in their care. Patients need to be of Health Sciences, Makerere University, Kampala, Uganda. 4 School of Public
encouraged to provide feedback regarding the involve- Health, College of Health Sciences, Makerere University, Kampala, Uganda.
ment of medical students in their care. These feedback 5
Department of Medical Microbiology and Immunology, Faculty of Medicine,
Gulu University, Gulu, Uganda. 6 Department of Anatomy, School of Biomedical
can inform decisions of medical educators and pre- Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
ceptors on how to best train medical students without
infringing on patients’ autonomy. Received: 20 November 2021 Accepted: 16 June 2022

Supplementary Information
The online version contains supplementary material available at https://​doi.​
org/​10.​1186/​s12909-​022-​03576-4. References
1. Spencer J, Blackmore D, Heard S, McCrorie P, McHaffie D, Scherpbier A,
Additional file 1. Study tool. et al. Patient-oriented learning: a review of the role of the patient in the
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