title: 'They've all got to learn'. Medical students' learning from patients in ambulatory (outpatient and general practice) consultations.
abstract: BACKGROUND
  The dynamics of effective teaching consultations need to be better understood.
  
  
  OBJECTIVE
  Find from medical students, patients and doctors how to optimize learning in ambulatory consultations.
  
  
  METHODS
  Patients and students independently gave semi-structured exit interviews after 25 ambulatory teaching consultations during a clinical attachment set up experimentally to strengthen students' ambulatory learning. The results of an abbreviated grounded theory analysis were checked in three focus group discussions with teachers and students.
  
  
  RESULTS
  Patients and students identified strongly with one another and benefited from teaching consultations in parallel ways yet defaulted to passive roles. Patients deferred to professional expertise whilst students were uncertain what was expected of them, feared harming patients and feared being showed up as ignorant. The educational value of consultations was determined by doctors' ability to promote student-patient interaction.
  
  
  CONCLUSIONS
  In the most effective teaching consultations, doctors promoted a level of participation that realized patients' and students' mutual sense of responsibility by orientating them to one another, creating conditions for them to interact, promoting and regulating discourse, helping students to perform practical tasks and debriefing them afterwards. Those broad conclusions translate into 18 practical recommendations for supervising a medical student in an outpatient clinic or surgery.
authors.affiliation: University of Manchester Medical School, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Ashley
authors.forename: Nick
authors.initials: N
authors.lastname: Rhodes
authors.forename: Hanadi
authors.initials: H
authors.lastname: Sari-Kouzel
authors.forename: Annice
authors.initials: A
authors.lastname: Mukherjee
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan