Residents' Agreement: Groups in clinical classes can't be a dozen people. Among other things, it is about the dignity of patients

- Clinical classes often lead to the formation of master-student relationships between teachers and students. Personally, I remember how important they were to me as a student, and despite the passage of years, I still have in front of my eyes the patients I met in my classes and the teachers who introduced me to the secrets of medicine. Now, being on the other side, my job is to show young medical students what clinical medicine is all about. However, these classes are not only about teaching how to correctly take a history and conduct a physical examination, but also, and perhaps most importantly, about learning the right approach and conversation with the patient, developing sensitivity and empathy - values that shape the attitude of future doctors," says Professor Wojciech Szczeklik, MD, Head of the Department of Anesthesiology and Intensive Care, 5th Military Clinical Hospital with Polyclinic in Krakow.

- Such classes should be held in small groups, optimally not exceeding 4 people. I cannot imagine conducting them in a group of, say, 15 people. In addition to the obvious lack of benefit for learners, this situation is also unacceptable for practical reasons. It is impossible to accommodate such a number of people in the operating room, and it becomes impossible to conduct classes at the bedside of a critically ill patient in the intensive care unit. In both situations, too large a group size can also pose a danger to the patient," adds Prof. Szczeklik.

Prof. Jerzy Sienko, MD, provincial consultant in general surgery for the West Pomeranian region, points out that every academician involved in the process of training future doctors takes on a huge responsibility for the patients who will be treated by these doctors in the future. It is also important to respect the dignity of the patient.

- Bringing, for example, 15 students into the patient's room to conduct an examination, including an interview that often hooks into very intimate issues, will undoubtedly cross the psychological comfort barrier of such a patient. I cannot imagine the presence of such a large group of students in the operating room. First of all, this represents an unnecessary increase in epidemiological risk, and secondly, it limits the space of the operating room. It would be unacceptable to have a situation in which the operator needs, for example, an urgent replacement of a suction machine when there is intense bleeding, and the instrument assistant, wanting to administer it, cannot get through the crowd of students," points out Prof. Jerzy Sienko.

Working with patients struggling with mental illnesses also requires a special approach. According to Prof. Dominika Dudek, MD, Head of the Department of Psychiatry and Department of Adult Psychiatry at the Jagiellonian University Medical College, the practical teaching of psychiatry should take place in the smallest possible - groups of several students (2-6 people). Diagnosis in psychiatry is based primarily on history and observation of the patient. On the one hand, the student must have the opportunity to interview the patient, and on the other hand, the patient must have the comfort and intimacy of contact.

- Meeting with a large group can generate the patient's anxiety and reluctance to disclose his experiences. While pursuing didactic goals, we must not forget about the welfare of the patient, and in psychiatry the sphere we touch is particularly sensitive and delicate. From the point of view of the student - in a large group he may not even have the opportunity to ask the patient a question, let alone acquire the ability to make contact. An important aspect of teaching is learning about consultative psychiatry, that is, mental disorders in patients treated for somatic conditions. Accompanying an academic who is a consulting psychiatrist is essential here, and it is difficult to imagine that this could be done in a large group," stresses Prof. Dominika Dudek.

Prof. Marcin Tkaczyk, MD, chairman of the Polish Society of Pediatric Nephrology and head of the Department of Pediatrics, Immunology and Nephrology at the Polish Mother's Memorial Health Center in Lodz, is of the opinion that increasing the number of students in practice groups is illogical and has a direct negative impact on the quality of education. It will make it more difficult to demonstrate, test skills in the same unit of time, supervise the work of smaller groups of students, and increase the workload falling on a doctor who, in addition to his or her teaching duties, is at the same time doing work for the same patients who have agreed to be examined by the students.

- In pediatrics, which I've been teaching practically for 15 years, patient contact, intimacy and the consent of the parent is extremely important, protecting their child from the disease, but also from the stress of a hospital stay. An examination in a group of 5-6 people is a challenge to maintain appropriate standards, let alone if there are 10 students including the attending physician in one patient room. Such conditions compromise intimacy and make the parent reluctant to consent to the examination. Hospitals are not locally prepared to allow such large groups of students to examine children, the professor believes.

Prof. Miroslaw Wielgos, MD, head of the Department of Obstetrics and Perinatology at the National Medical Institute of the Ministry of Internal Affairs and Administration, and rector of the Warsaw Medical University for the 2016-2020 term, in turn, stresses that the education of students in the medical field is an extremely demanding issue, in which the key role is played by its quality. This involves taking classes not only in theory, but also, and perhaps most importantly, in practice. Although nowadays we already have extensive training opportunities using simulation methods, nothing can replace the direct contact of the student with a real patient. However, many difficulties are encountered in this aspect.

- First, the limited willingness of patients to engage in the educational process. Secondly, an insufficient number of qualified teaching staff with not only strictly professional experience, but who also have both the gift and the desire to impart their knowledge to medical students. And finally, thirdly, practical training in too large student groups. If a practice group consists of a dozen students, such teaching ceases to be effective and completely loses its meaning," he adds.