Project to decrease medical student refusal in the Obstetric and Gynecology Clinic at the University of Iowa

Purpose: To describe the frequency at which students are refused from patient care, and to evaluate the impact of interventions designed to reduce medical student refusal. Background: Medical student refusal from patient care is perceived to be a common problem during the Ob-Gyn clerkship at the University of Iowa. Review of the literature shows that medical student refusal is common in a variety of clerkships1-4. Few studies have evaluated interventions to reduce the rate of refusal. Methods: Beginning in 2016, surveys measuring medical students’ perception of refusal were administered upon completion of the Ob-Gyn clerkship. Interventions to reduce refusal of medical student participation were implemented and/or modified with each subsequent clerkship block starting in 2017. Results: Over the 2017 calendar year, 86% (85% among females and 88% among males) of students reported being refused from patient interaction in any clerkship because they are a medical student, 88% reported being refused in their Ob-Gyn clerkship because they are a medical student, and 85% percent of male students reported being refused in their Ob-Gyn clerkship because of their gender. The data show no clear correlations with refusal and gender nor with the interventions put in place. Multiple qualitative responses describe patient discomfort with the presence of male students. Discussion: The data suggest that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender based exclusion may be a related problem. So far, the data have not shown a clear improvement following interventions. Possible explanations are explored and future interventions are discussed.