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Awareness of the Rules by Relevant Personnel and Patients

The second step is to ensure that everyone involved with the teaching program understands the importance of the rules governing medical student behavior. Before students start to work in the practice, they should be given a copy of the rules. They should be encouraged to read them before reporting to work and should be given a brief quiz on them when they start work. The staff should also be given copies of the rules. Staff members should be told in some detail about the limits of the students' freedom of action and should be warned that, if there is any question about whether an order by a student should be authorized, they should consult the physician responsible for the student. The physicians, in turn, must be careful never to rebuke a staff member for requiring verification of a student order.

Beyond the staff, there are other persons who should be notified that the practice will include the teaching of medical students. The largest class of persons that should be so informed is the patients. It would be well to give all patients a written consent to sign; the consent should include a description of the roles that the medical students will fill and a statement that the patients may refuse to be seen by medical students. This consent should authorize the involvement of medical students in the patient's care, but it cannot expand the legal limits on medical student behavior established by the state's medical practice act. The physician should be careful to honor the patient's wishes if the patient chooses not to be seen by medical students.

The physician should also notify any outside parties who deal with physician orders and who may confuse the new medical students with physicians. Contract nurses pose the greatest risk in this respect. A contract nurse may come into the practice for a few days to cover an absent staff nurse and may come into the practice for a few days to cover an absent staff nurse and may be unfamiliar with the physicians and students. It is very difficult for such a nurse to know whose orders must be verified unless this is included in the orientation for all contract nurses and new personnel.

Outside laboratory group should also be notified. Independent contractor groups should have a list of all persons authorized to order medical services. This list should be kept up-to-date, and the contractors should be cautioned that any services performed without proper authorization will not be paid for.

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