SQU Med J, December 2010, Vol. 10, Iss. 3, pp. 377-381, Epub. 14th Nov 10
Submitted 9th Jan 10
Revision ReQ. 14th June 10, Revision Recd. 24th June 10
Accepted 13th July 10

College of Medicine, Taibah University, Almadinah Almuhawwarah, Saudi Arabia
*Corresponding Author email: dr.manaalb@hotmail.com

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aBstract: Objectives: Outpatient clinics are a key element in dermatology health service provision thus 
making them an excellent place for intern and medical student rotations. However, this requires that patients are 
willing to interact with these trainees. This study assessed the attitudes of patients towards interns and medical 
students rotating in dermatology clinics. Methods: All 112 patients interacting with medical students and interns 
at dermatology clinics at King Fahad Specialist Hospital in Almadinah Almunawwarah region, Saudi Arabia, 
from September to November 2009 completed a cross-sectional survey, which assessed their acceptance of these 
trainees. Results: Ninety-eight of 112 patient responses were valid. A total of 44 (44.9%) of these 98 patients 
had a chance to interact with 1–3 medical students or interns during their visit. The majority of the patients 
preferred the treating physician to be present during history taking by the interns and students. A majority of 
patients preferred that their physical examination be done by the physician alone (61.2%), whereas others (26.5%) 
preferred an intern with the physician. Both male and female patients preferred that their health care provider 
be of the same sex. Conclusion: The patients in dermatology clinics accept the services of interns and students, 
while also expecting privacy. Therefore, interns and students should be confident when taking patient histories 
and performing physical examinations.

Keywords: Attitude; Dermatology; Medical students

BRIEF COMMUNICATIONBRIEF COMMUNICATION

Patient Attitudes towards Interns and Medical 
Students rotating in Dermatology Clinics in 

Almadinah Almunawwarah Region, Saudi Arabia
*Mana Al-Harbi and Khalid Al-Harbi

Advances in Knowledge
1. This study showed that patients have favorable attitudes toward medical students and teaching processes even in the most conservative 

cultures in Saudi Arabia.
2. It also highlighted some points which increase patients' acceptance of medical students: 1. the physician should explain to patients the 

importance of clinical experience in medical student teaching ; 2. health care should be provided by a trainee/physician of the same sex, 
especially for female patients; 3. the number of students interacting with each patient should be minimised; 4. patient examination 
should be performed by a physician, with student participation possibly requested from cooperative patients.



Patient Attitudes towards Interns and Medical Students rotating in Dermatology Clinics  
in Almadenah Almunawwarah Region, Saudi Arabia

378 | SQU Medical Journal, December 2010, Volume 10, Issue 3 brief communication | 378

Application to patient care
1. Students should have more confidence in dealing with patients when they realise that patients have a favorable attitude towards them; this 

will make the teaching and health care process go more smoothly. 
2. In order to increase patient satisfaction and minimise their rejection by patients, students should avoid examining patients alone without 

presence of the treating physician.
3. More clinical exposure for students will result in better doctors participating in a positive way in health care.

Outpatient clinics are a key element  in dermatology health service provision thus making them an excellent place 
for intern and medical student learning.1 Thus, 
medical students who are rotating in dermatology 
obtain considerable benefit from their learning 
experience in these clinics. This also gives them 
more opportunity to interact with patients and their 
relatives than in any other specialty. A large number 
of patients in our dermatology clinic are females 
so they might refuse student participation in their 
care due to concerns about privacy or because of 
their conservative cultural background. The latter 
is especially true in the Almadinah Almunawwarah 
region location of Al Madinah, the second most 
important Islamic city in Saudi Arabia. 

Interestingly, several investigators have found 
patient attitudes toward medical students to 
be favourable in internal medicine and surgery 
clinics.1,2,3 Similar studies conducted in dermatology 
clinics inside and outside Saudi Arabia have shown 
that a large percentage of patients accept the 
participation of medical students in their care.4,5 
Prior information about the presence of a medical 
students and their specific role during clinical 
examination was felt to be essential by a significant 
number of patients.6 

However, the patient acceptance of medical 
students and interns has not been studied in the 
Almadinah region of Saudi Arabia. This region 
has a medical college with the medical students 
undertaking their formal and elective rotations in 
both King Fahad Specialist Hospital (KFSH) and 
Auhd Hospital. The objective of this research was 
therefore to study attitudes of patients toward 
interns and medical students who rotate in the 
dermatology clinics in Almadinah region. 

Methods
This cross-sectional survey was conducted at 
KFSH in Almadinah Almunawwarah region in 

the two month period, September to November 
2009. The survey consisted of 15 questions on 
patient demographic information and preferences 
regarding medical student participation in providing 
health services and participating in clinical 
examination.  The questionnaire and study protocol 
were obtained from a previous study, the authors 
also providing us with an Arabic translation.1 We 
then modified the questionnaire to include medical 
interns, to see if there would be any difference in 
patient acceptance of students as compared to the 
interns (see questionnaire in annexe). We tested 
the questionnaire in a pilot study which included 
15 patients. Data were collected by distributing the 
self-reported questionnaires in consultation rooms 
in dermatology clinics at KFSH and Auhd Hospital. 
The questionnaires were distributed to all those 
patients who were managed by interns and medical 
students. The respondents were asked to choose 
the most relevant response. The 112 returned 
questionnaires, of which 14 were discarded due to 
incomplete data, were analysed using the Statistical 
Package for Social Sciences (SPSS) for Windows, 
Version 17.0 (SPSS Inc., Chicago, IL, USA). A P 
value of <0.05 was used for statistical significance. 
Approval for this study was obtained from the 
Medical College of Taibah University, Saudi Arabia.

Results 
Ninety-eight patients from dermatology clinics were 
included in this study. Their mean age was 24.3 ± 6.2 
years; 59% were female and all had received some 
education with 52.6% having college education or 
above. During their visit to the dermatology clinics, 
forty-four patients (44.9%) interacted with 1–3 
medical students, while 15.3% interacted with 3–4 
students [Table 1].

 Regarding patient preferences for intern 
and medical student participation in outpatient 
dermatology clinics, 60.2% of respondents 
preferred to see students with the physician while 



Mana Al-Harbi and Khalid Al-Harbi

brief communication | 379

21.4% preferred to see the physician alone. Similar 
figures were obtained for intern participation:  
57.1% preferred to see interns with the physician 
and 23.5% preferred to see the physician alone 
[Table 2].

Regarding participation of students in the 
physical examination, 61.2% of respondents 
preferred to see the physician alone and 
26.5% preferred interns in the presence of the  
treating physician; only 4.1% preferred to see 
students with the physician as shown in the  
Table 2. 

Patient responses to a variety of preference 
questions are listed in Table 3. As shown, 78.6% 
preferred to see students of the same sex, whereas 
21.4% did not mind about the sex of the student. 
All female patients wanted a same sex health care 

provider, whereas 63.8% of male patients wanted 
male students and interns. This difference between 
males and females was statistically significant (P 
= 0.00). Of the study participants, 77.5% wanted 
to discuss their health problems alone with their 
physician, while 39.7% agreed to disclose personal 
health information in front of medical students and 
interns.

The majority of the patients (67.4%) stated that 
they enjoyed interacting with medical students in 
outpatient dermatology clinics. Out of those who 
were involved in the study, 42.9% felt that they got 
more attention from their physician in the presence 
of the medical students, and 56.1% felt that the 
students understood their health needs. The chi-
square test showed a statistically insignificant 
relationship between number of medical students 
and patient acceptance of them participating in 
the clinic (P = 0.18). On the other hand, there was 
a statistically significant relationship between the 
number of the students and their acceptance by 
patients during clinical examination (P = 0.00). Also 
the sex of the patient and that of the care giver was a 
significant factor during the examination (P = 0.01).  

Discussion
The attention given to patient-medical student 
interaction in medical literature is very much 
deserved and needs to be sustained.7 Medical student 
participation in outpatient clinics is an integral 
component of their medical school education and 
the patients are often the focal point of the teaching 
process. Patient’s willingness and comfort level 

Table 1: Demographic data of dermatology clinic 
patients

No. (%)

Age (mean ± standard deviation)
   Female
   Male

24.3 ± 6.2
58 (59.2)
40 (40.8)

Education
   Intermediate or less
   Secondary
   Technical school
   College graduate
   Postgraduate study

12 (12.2)
31 (31.6)

4 (4.1)    
38 (38.8)
13 (13.8)

Number of students seen in previous visit
   None
   1–3
   4–5
   >5

39 (39.8)
44 (44.9)
15 (15.3)

0

Table 2: Patient preferences in regards to medical students and interns

Total
n (%)

Male
n (%)

Female
n (%) 

P value

Medical student participation
    Physician alone
    Student with physician
    No preference

98 (100)
21 (21.4)
59 (60.2)
18 (18.4)             

58 (59.2)
12 (57.1)
30 (50.8)
16 (88.9)

40 (40.8)
9 (42.9)

29 (49.1)
 2 (11.1) 

< 0.016

Intern participation
    Physician alone
    Intern with physician
    No preference

98 (100)
23 (23.5)
56 (57.1)
19 (19.4)

58 (59.2)
9 (39.1)

30 (53.6)
19 (100)

40 (40.8)
14 (60.9)
26 (46.4)

0

<0.00

Physical examination
    Physician alone
    Intern with physician
    Student with physician
    No preference

98 (100)
60 (61.2)
26 (26.5)

4 (4.1)
8 (8.2)

58 (59.2)
38 (63.3)
11(42.3)

1(25)
8 (100)

40 (40.8)
22 (36.7)
15 (57.7)

3 (75)
0

< 0.012



Patient Attitudes towards Interns and Medical Students rotating in Dermatology Clinics  
in Almadenah Almunawwarah Region, Saudi Arabia

380 | SQU Medical Journal, December 2010, Volume 10, Issue 3

regarding the involvement of a medical trainee 
in their care may be affected by their previous 
experience with trainees, their understanding of the 
role and responsibilities of trainees, and the nature 
of the medical problem.8

Our study showed that patients had a favorable 
attitude toward medical student and intern 
participation in their health care. The majority 
of patients preferred the presence of the treating 
physician alongside the trainees, and preferred 
to undergo physical examination by the physician 
alone. The attitude toward interns was more 
favourable compared to medical students. All of the 
female patients wanted to deal with female students, 
whereas over 60% of males preferred to deal with 
male students. Amongst the study participants, 
39.7% did not mind disclosing personal information 
to the students. The majority of patients enjoyed 
interacting with the students and felt that the 
students understood their health needs. 

Although the results of attitudes of the patients 
were positive for acceptance of the student 
participation in the dermatology clinics, the figures 
were less than those in the study by Townsend et 
al. which was carried out in the USA.2 This might 
be due to cultural differences between the two 
countries as Saudi Arabia has a more conservative 
culture. It could also be due to the large percentage 
of female patients (59.2%) in our study. 

Based on the results of our study, we would like 
to suggest some points that might make medical 
student and intern participation in dermatology 
clinics easier and more acceptable. The physician 
should try to explain to the patients the importance 
of direct interaction with patients in medical 
student teaching. Health care should also preferably 
be provided by a trainee/physician of the same sex, 

especially for the physical examination of female 
patients. The number of trainees interacting with 
each patient should be minimised. Examination 
of patients, especially of the private organs, should 
be performed by a physician alone, but student/
intern participation in physical examination may be 
requested from cooperative patients. 

Conclusion
In the Al-Madenah Al-Munawwarah region, 
medical student and intern participation is generally 
accepted by patients in dermatology clinics and 
therefore they should be confident during history 
taking and examination, while making efforts to 
maintain patient privacy.

a c k n o w l e d g m e n t s

We are grateful to Dr. I Bukhari4 for her help with 
data collection sheets and to all those who helped 
us in preparing this manuscript.    

c o n f l i c t o f i n t e r e s t
The authors reported no conflict of interest. 

References
1. Simons RJ, Imboden E, Martel JK. Patient attitudes 

toward medical student participation in a general 
internal medicine clinic. J Gen Intern Med 1995; 
10:251–4.

2. York NL, Da Rosa DA, Markwell SJ, Niehaus AH, 
Folse R. Patients' attitudes toward the involvement 
of medical students in their care. Am J Surg 1995;  
169:421–3.  

3. AlSultnan A, Parashar S, AlGhamdi A. Electives 
during medical internship. Saudi Med J 2003; 
24:1006–9.

Table 3: Distribution of Patient Preferences towards the medical trainees

Strongly 
agree

Agree Undecided Disagree Strongly 
disagree

1. Prefer same sex 39 (39.8) 38 (38.8) 5 (5.1) 16 (16.3) 0

2. Wanted time alone with physician 54 (55.1) 22 (22.4) 21(21.4) 1(1) 0

3. Will disclose personal info in front 
of trainees

17 (17.3) 22 (22.4) 34 (34.7) 7 (7.1) 18 (18.4)

4. Enjoyed interacting with trainees 27 (27.6) 39 (39.8) 6 (6.1) 21(21.4) 5 (5.1)

5. Received more attention when 
trainee present

24 (24.5) 18 (18.4) 42 (42.9) 12 (12.2) 2 (2)

6 Trainees understood my health needs 25 (25.5) 30 (30.6) 24 (24.5) 12 (12.2) 7 (7.1)



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