title: Who gets "kicked out" of the exam room? Factors associated with patients declining medical student participation.
abstract: BACKGROUND
  Research on patients' decision to have medical students participate in clinical care has been examined predominantly from the patients' perspective rather than the students' perspective.
  
  
  OBJECTIVE
  This study investigated 3rd-year medical students' experiences with and perceptions of patients declining medical student participation in clinical care and identified factors associated with this decision.
  
  
  METHODS
  Third-year medical students (n = 103) completed a survey assessing demographic background, experiences with patients declining medical student participation in clinical care, preceptors' approach to obtaining patient consent for student participation, and ratings of preceptors' clinical education skills.
  
  
  RESULTS
  Fifty-nine percent, 22%, and 25% of students encountered patients declining student involvement in care (3 times or more) based on student's training status, student's gender, and in the context of a gynecological/urological exam, respectively. Patient consent obtained by clinic staff (r =.661, p < .001) was a significant predictor for patients declining based on training status. Gender (d = 40, p < .003) and patient consent obtained by clinic staff (r = .349, p < .001) were predictors of patients declining in the context of a gynecological/urological exam.
  
  
  CONCLUSIONS
  A majority of medical students have encountered multiple experiences with patients declining student participation in outpatient clinical care. The approach preceptors use to obtain patient consent may be important in increasing training opportunities for students.
authors.affiliation: Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA. tangts@umich.edu
authors.forename: Tricia S
authors.initials: TS
authors.lastname: Tang
authors.forename: Eric P
authors.initials: EP
authors.lastname: Skye
mesh_terms: D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008297:Male; D010808:Physical Examination; D010817:Physician-Patient Relations; D013337:Students, Medical; D016312:Treatment Refusal