{"id":71219,"date":"2021-12-13T08:12:41","date_gmt":"2021-12-13T00:12:41","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=71219"},"modified":"2022-04-05T11:02:06","modified_gmt":"2022-04-05T03:02:06","slug":"patients-attitude-and-factors-influencing-the-acceptance-of-medical-students-participation-in-pelvic-examination","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/patients-attitude-and-factors-influencing-the-acceptance-of-medical-students-participation-in-pelvic-examination\/","title":{"rendered":"Patients\u2019 attitude and factors influencing the acceptance of medical students\u2019 participation in pelvic examination"},"content":{"rendered":"<p>Submitted: 21<span lang=\"EN-GB\"> April 2021<\/span><br \/>\r\nAccepted: 7 October 2021<br \/>\r\nPublished online: <span lang=\"EN-GB\">4 January, TAPS 2022, <\/span><span lang=\"EN-GB\">7(1), 87-97<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2022-7-1\/OA2519\">https:\/\/doi.org\/10.29060\/TAPS.2022-7-1\/OA2519<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Nisakorn Deesaen<sup>1<\/sup>, Kongpop Sutantikorn<sup>1<\/sup>, Punyanuch Phonngoenchai<sup>1<\/sup>, Sakchai Chaiyamahapruk<sup>2<\/sup><\/span><span lang=\"EN-US\"> &amp; Patcharada Amatyakul<sup>3<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-US\">1<\/span><\/sup><\/i><i><span lang=\"EN-US\">Faculty of Medicine, Naresuan University, Thailand; <sup>2<\/sup>Department of Community Medicine, Faculty of Medicine, Naresuan University, Thailand; <sup>3<\/sup>Department of Obstetrics and Gynaecology, Faculty of Medicine, Naresuan University, Thailand<\/span><\/i><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><b><span lang=\"EN-GB\"> <\/span><\/b><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Introduction<\/span><\/b><b><span lang=\"TH\">:<\/span><\/b><span lang=\"TH\"> <\/span><span lang=\"EN-GB\">Pelvic examination of patients in the department of obstetrics and gynaecology <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">Ob<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">Gyn<\/span><span lang=\"TH\">)<\/span><span lang=\"EN-GB\"> is an important skill for medical students<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Because it involves a physical assessment of the patients&#8217; genitalia, patients may refuse medical students to participate in the examination, affecting the medical students&#8217; clinical skills<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Methods<\/span><\/b><b><span lang=\"TH\">:<\/span><\/b><span lang=\"TH\"> <\/span><span lang=\"EN-US\">This cross<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">sectional study was conducted at Naresuan University Hospital to determine the factors that influence the acceptance of medical student participation in the pelvic examinations<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">A total of 198 out<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">patients from the Ob<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">Gyn department were included<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">A Likert scale questionnaire was designed which featured topics on patients<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-US\">attitudes and circumstances related to medical student involvement in gynaecological procedures.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Results<\/span><\/b><b><span lang=\"TH\">:<\/span><\/b><span lang=\"TH\"> <\/span><span lang=\"EN-US\">The majority of outpatients <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-US\">71<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\">7<\/span><span lang=\"TH\">%) <\/span><span lang=\"EN-US\">accepted the participation of medical students in pelvic examinations<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">Patients with prior experiences in physical and pelvic examination by medical students had a significant impact on the patients&#8217; acceptance <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-US\">P<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">value&lt;0<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\">001<\/span><span lang=\"TH\">).<\/span><span lang=\"TH\"> <\/span><span lang=\"EN-US\">The patients<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-US\">impressions had an influence on the decision to accept students in pelvic exam participation<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">Approximately 40<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-US\">of patients were concerned about the breach of confidentiality<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">However, most patients strongly agreed that allowing medical students to perform <\/span><span lang=\"EN-US\">pelvic examination<\/span><span lang=\"EN-US\"> would benefit their medical education<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Conclusion<\/span><\/b><b><span lang=\"TH\">:<\/span><\/b><span lang=\"TH\"> <\/span><span lang=\"EN-GB\">Most of the participants permitted medical students to participate in pelvic examinations and preferred that the medical instructor be the one to request permission. The patients<\/span><span lang=\"TH\">\u2019<\/span><span lang=\"EN-GB\"> impressions of medical students were crucial factors that significantly influence their decision whether to allow<\/span><span lang=\"EN-US\"> or deny<\/span><span lang=\"EN-GB\"> them to participate in the procedure<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Disclosure of confidentiality was found to be matters of concern <\/span><span lang=\"EN-US\">to most patients.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <i>Pelvic Examination, Medical Students, Acceptance, Performance, Clinical Teaching<\/i> <\/span><b><i><span lang=\"EN-GB\"><\/span><\/i><\/b><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Most of the patients consent to a medical student participating in a pelvic examination.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Medical instructors should ask for patients\u2019 permission.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Confidentiality and privacy of patients are critical issues that must be addressed.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Patients&#8217; impressions and prior examination experiences by medical students influence patients&#8217; decisions.<\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<ol><\/ol>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Medical students should learn how to perform pelvic examinations on patients during clinical years<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">History taking, physical examination, and pelvic examination are taught during the fourth to sixth year of medical training in our curriculum<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">Pelvic examination is defined as the assessment of external genitalia, speculum examination of the vagina and cervix, bimanual palpation of the uterus, adnexa and sometimes rectovaginal examination<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">This procedure is used to screen for gynaecological diseases and cancers in asymptomatic women and to diagnose gynaecological diseases in symptomatic women<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">Pelvic examination differs from other physical examinations because it involves an inspection of the genitalia, which, according to studies, commonly causes anxiety, fear, embarrassment <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-US\">10<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">80<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-US\">of women<\/span><span lang=\"TH\">)<\/span><span lang=\"EN-US\">, pain, and discomfort <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-US\">11<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">60<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-US\">of women<\/span><span lang=\"TH\">) (<\/span><span lang=\"EN-US\">B<\/span><span lang=\"EN-US\">loomfield et al<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\">, 2014<\/span><span lang=\"TH\">). <\/span><span lang=\"EN-US\">Some factors why patients feel uncomfortable during a physical examination by medical students are concerns about privacy, confidentiality, and embarrassment<\/span><span lang=\"TH\"> (<\/span>Rizk et al<span lang=\"TH\">.<\/span>, 2002<span lang=\"TH\">). <\/span><span lang=\"EN-US\">As a result, patients may refuse to allow medical students to participate in the pelvic examination, affecting the learning experience and clinical skills of medical students<\/span><span lang=\"TH\">. <\/span>Furthermore, factors related to age, race, religion, cross<span lang=\"TH\">&#8211;<\/span>cultural differences, marital status, and previous delivery may also influence the patients<span lang=\"TH\">\u2019 <\/span>decision to allow medical students in conducting pelvic examination (Anfinan et al., 2014; McLean et al., 2010)<span lang=\"TH\">. <\/span>Compared to other ethnic and religious groups, Muslim women had a higher rate of refusing medical students, particularly male students <span lang=\"TH\">(<\/span><span lang=\"EN-GB\">Nicum &amp; Karoo, 1998<\/span><span lang=\"TH\">)<\/span><span lang=\"TH\">.<\/span><span lang=\"TH\"> <\/span><span lang=\"EN-GB\">During intrapartum care, approximately 50<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">of Hindu and Muslim patients refused to accept medical students<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Sikh and Muslim patients accepted only female medical students, 41<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">and 40<\/span><span lang=\"TH\">%<\/span><span lang=\"EN-GB\">, respectively, whereas 59<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">of Christian patients accepted both female and male medical students <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">Nicum &amp; Karoo, 1998<\/span><span lang=\"TH\">). <\/span><span lang=\"EN-GB\">However, patients\u2019 reasons for accepting and refusing medical student participation in pelvic examination<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">have not been established in South<\/span><span lang=\"EN-GB\">e<\/span><span lang=\"EN-GB\">ast Asia because of <\/span><span lang=\"EN-US\">limited<\/span><span lang=\"EN-GB\"> investigation.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\">According to the patient<span lang=\"TH\">\u2019<\/span>s bill of rights, patients have a right to accept or refuse the medical students<span lang=\"TH\">\u2019 <\/span>participation<span lang=\"TH\">. <\/span>They should have the opportunity to decide if they want to contribute to the medical education or decline care from medical students <span lang=\"TH\">(<\/span>Teunissen, 2018<span lang=\"TH\">). <\/span>Approximately 26<span lang=\"TH\">% <\/span>of the patients refused to have a medical student perform a pelvic examination <span lang=\"TH\">(<\/span><span lang=\"EN-US\">Fortier et al<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\">, 2006<\/span><span lang=\"TH\">). <\/span><span lang=\"EN-US\">Previous study reported that the <\/span><span lang=\"EN-US\">refusal rate increased as the level of student involvement increased, from observation to history taking to examinations and procedure, particularly with digital vaginal and rectal<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">examination<\/span><span lang=\"TH\"> (<\/span><span lang=\"EN-US\">Salah et al<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-US\">, 2015<\/span><span lang=\"TH\">). <\/span><span lang=\"EN-US\">In contrast, some patients accepted the medical students<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-US\">participation because they wanted to<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">contribute to<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">the clinical training in medical education<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">Because of the training process, the patients felt more confident that they would receive appropriate treatment<\/span><span lang=\"EN-US\">s<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">From the literature review, most studies were conducted in developed and some Arab countries<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">There are limited data from women in Southeast Asia countries on the factors and attitudes that influence their decision whether they allow or refuse medical students to participate in a pelvic <\/span><span lang=\"EN-US\">examination<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">This research aimed at studying the patients<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-US\">characteristics, influencing factors and correlation with the acceptance of medical students,<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">which may increase the <\/span><span lang=\"EN-US\">Ob<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">Gyn patients to participate <\/span><span lang=\"EN-US\">in clinical education<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This cross<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">sectional descriptive study was conducted at the out<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">patient unit of the Department <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">OPD<\/span><span lang=\"TH\">) <\/span><span lang=\"EN-GB\">of Obstetrics and Gynaecology, Naresuan University Hospital<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">P<\/span><span lang=\"EN-GB\">atients who visited Ob<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">Gyn department between November 2018 and May 2019<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">were<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">included in the study<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Patients under 20 years old, mentally or critically ill and unable to understand the questionnaire in Thai language were excluded in this study<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">All the participants were able to complete the consent forms and questionnaires independently, and were guaranteed anonymity.<\/span><span lang=\"EN-GB\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The questionnaire was developed to evaluate 4 domains, as follows<\/span><span lang=\"TH\">: (<\/span><span lang=\"EN-GB\">1<\/span><span lang=\"TH\">) <\/span><span lang=\"EN-GB\">demographic and socio<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">economic data <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">age, gender, educational level, occupation and parity<\/span><span lang=\"TH\">)<\/span><span lang=\"EN-GB\">, <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">2<\/span><span lang=\"TH\">) <\/span><span lang=\"EN-GB\">patient preference,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">3<\/span><span lang=\"TH\">) <\/span><span lang=\"EN-GB\">f<\/span><span lang=\"EN-GB\">actors influencing patient receptivity of medical student<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">involvement in pelvic examination<\/span><span lang=\"TH\"> (<\/span><span lang=\"EN-GB\">gender, hygiene, manner and<\/span><span lang=\"EN-GB\"> demeanour<\/span><span lang=\"EN-GB\">,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">patient<\/span><span lang=\"EN-GB\">s\u2019<\/span><span lang=\"EN-GB\"> impressions<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">of the medical students, prior experience in physical and pelvic examination), and <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">4<\/span><span lang=\"TH\">) <\/span><span lang=\"EN-GB\">patients\u2019 <\/span><span lang=\"EN-GB\">attitudes toward <\/span><span lang=\"EN-US\">accepting medical students to conduct pelvic examination under supervision of<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">medical instructors.<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">Influencing factors and attitudes included in the questionnaire were modified based on a literature review<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">A 5<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">point Likert scale was used to determine the level of agreement<\/span><span lang=\"TH\"> (<\/span><span lang=\"EN-GB\">1<\/span><span lang=\"TH\">=<\/span><span lang=\"EN-GB\"> strongly agree; 2<\/span><span lang=\"TH\">= <\/span><span lang=\"EN-GB\">agree; 3<\/span><span lang=\"TH\">= <\/span><span lang=\"EN-GB\">neutral; 4<\/span><span lang=\"TH\">= <\/span><span lang=\"EN-GB\">disagree; and 5<\/span><span lang=\"TH\">= <\/span><span lang=\"EN-GB\">strongly disagree<\/span><span lang=\"TH\">).<\/span><span lang=\"TH\"> <\/span><span lang=\"EN-GB\">The questionnaire was initially tested for content validity using the item-objective congruence (IOC) index, and then used in a pilot study on 30 patients who were not included in the study to ensure clarity and reliability.<\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">A. Statistical Analysis<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A Microsoft Excel spreadsheet was created for data entry and statistical analysis<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Descriptive data was presented in the form of frequency, mode, and percentage. Chi-square test was calculated for proportions<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">The p<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">value of less than 0<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">05 was considered statistically significant<\/span><span lang=\"TH\">.<\/span><\/p>\r\n<p style=\"text-align: left\"><i><span lang=\"EN-GB\"><\/span><\/i><i><span lang=\"EN-GB\">B. Ethical Considerations<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">All collected data was kept confidential, and the information was used for research only<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">This study was approved by<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Naresuan University Institutional Review Board<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">in compliance with<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">the principles of the<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Helsinki Declaration<\/span><span lang=\"TH\">.\u00a0 <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">During the study period, 236 participants were recruited from the out<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">patient department of Ob<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">Gyn, but only 198 completed the questionnaire<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Most of them (99.0%) were aware that Naresuan University Hospital is a primary teaching hospital of the Faculty of Medicine, Naresuan University which provides clinical training for medical students and residents. The socio<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">demographic data of the study population are shown in Table 1<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">The data that supports the findings of this study are openly available at <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68\">http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68<\/a> (Amatyakul, 2021)<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-1-300x132.png\" alt=\"\" class=\" wp-image-71220 aligncenter\" width=\"621\" height=\"273\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-1-300x132.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-1-1024x450.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-1-768x338.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-1.png 1028w\" sizes=\"auto, (max-width: 621px) 100vw, 621px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. Demographics and characteristics of the study population<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">From 198 participants, 71<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">7<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">accepted the medical students to participate in pelvic examination<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Fifty<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">seven percent of the participants in the acceptor group <\/span><span lang=\"EN-GB\">allowed<\/span><span lang=\"EN-GB\"> both male and female medical students, while<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">42<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">9<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">in the same group allowed only female medical students<\/span><span lang=\"EN-GB\">. The correlation between patients<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-GB\">acceptance and <\/span><span lang=\"EN-GB\">refusal <\/span><span lang=\"EN-GB\">for the medical students to participate in pelvic examination showed that age, occupation and parity of the patients were not statistically different <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">p&gt;<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">0<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">05<\/span><span lang=\"TH\">). <\/span><span lang=\"EN-US\">Thirty<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-US\">one percent of bachelor\u2019s degree holders and 37<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-US\">of <\/span><span lang=\"EN-GB\">postgraduate <\/span><span lang=\"EN-US\">degree holders refused the participation of medical students<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-US\">The higher the patient&#8217;s educational attainment, the more likely they are to refuse a pelvic examination performed by medical students, as observed in this study<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">In the conduct of pelvic exam procedure, 69.3% of the patients in the acceptor group and 53.6% of the patients in the non-acceptor group felt comfortable with students present as observers. <\/span><span lang=\"EN-GB\">Before the students participate in a pelvic examination, most of the participants (81.4%) preferred that the medical instructors (56.6%) ask permission rather than the medical students (21.7%) or nurses (21.7%).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This research recorded 52<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">7<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">of the patients with prior experience of physical examination by medical students from other departments in Naresuan University Hospital.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Thirty<\/span><span lang=\"TH\">&#8211;<\/span><span lang=\"EN-GB\">two percent of the patients previously received pelvic examination by medical students <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">from our department or other medical training hospitals). <\/span><span lang=\"EN-GB\">Patients who had their physical examinations performed by medical students from other departments or had pelvic examinations performed by medical students had a statistically significant increase in allowing medical students to participate in pelvic examinations under the supervision of a medical instructor <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">Table 2<\/span><span lang=\"TH\">).<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-2-300x108.png\" alt=\"\" class=\" wp-image-71221 aligncenter\" width=\"659\" height=\"237\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-2-300x108.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-2-1024x367.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-2-768x276.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-2.png 1045w\" sizes=\"auto, (max-width: 659px) 100vw, 659px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. The correlation between the acceptance of medical student participation in pelvic examination and prior experience <\/span><span lang=\"EN-US\">of pelvic <\/span><span lang=\"EN-GB\">examination performed by medical students.<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The <\/span><span lang=\"EN-GB\">participants<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-GB\">decisions were influenced by their<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">impressions of medical students<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">More than 90<\/span><span lang=\"TH\">% <\/span><span lang=\"EN-GB\">of the participants<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">believed<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">that characteristics like<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">manner,<\/span><span lang=\"EN-GB\"> demeanour<\/span><span lang=\"EN-GB\">, cleanliness, hygiene, trustworthiness, and respect had a substantial<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">impact on their attitudes and acceptance<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">Similarly, the <\/span><span lang=\"EN-GB\">gender of the medical students also influenced the decision of the participants <\/span><span lang=\"TH\">(<\/span><span lang=\"EN-GB\">69<\/span><span lang=\"TH\">.<\/span><span lang=\"EN-GB\">2<\/span><span lang=\"TH\">%)<\/span><span lang=\"EN-GB\">,<\/span><span lang=\"EN-GB\"> which female students were<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">preferred<\/span><span lang=\"TH\">. <\/span><span lang=\"EN-GB\">The negative and positive <\/span><span lang=\"EN-GB\">attitudes of the patients related to medical student participation in pelvic examination are shown <\/span><span lang=\"EN-GB\">in <\/span><span lang=\"EN-GB\">Table 3<\/span><span lang=\"TH\">.<\/span><span lang=\"TH\"><\/span><\/p>\r\n<\/div>\r\n<p align=\"center\" style=\"text-align: left\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-3-300x201.png\" alt=\"\" class=\" wp-image-71222 aligncenter\" width=\"579\" height=\"388\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-3-300x201.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-3-768x515.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/11\/OA2519-Table-3.png 939w\" sizes=\"auto, (max-width: 579px) 100vw, 579px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 3. The <\/span><span lang=\"EN-US\">positive and negative <\/span><span lang=\"EN-GB\">attitudes of the participants about medical students<\/span><span lang=\"TH\">\u2019 <\/span><span lang=\"EN-GB\">participation in pelvic examination under the supervision of medical instructors.<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Our study demonstrated that 71.7% of the participants agreed to have their pelvic examinations performed by medical students. This result was comparable to the study of Western women that reported an acceptance rate ranging from 58 to 77% (Nicum &amp; Karoo, 1998<\/span>).<span lang=\"EN-GB\"> Conversely, our acceptance rate was lower when compared to a study conducted in United Arab Emirates by Rizk et al. (2002), in which 87.1% of the out-patients in Ob-Gyn accepted the involvement of medical students.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">According to the results of our study, there were no statistically significant differences between acceptors and non-acceptors in terms of age, educational level, occupation, parity, or prior pelvic examination. Hartz and Beal (2000) also reported similar findings, stating that the age and education of the patients were not statistically different between the two groups.\u00a0 However, Rizk et al. (2002) stated that the acceptance of the patients with older age, higher parity, and higher education was statistically significant. Interestingly, there was a trend discovered in our research that patients who are highly educated were more reluctant to allow medical students in performing pelvic examination, even when supervised by medical instructors. This reluctance could be because of a strong concern for their privacy, which should be investigated further through an in-depth interview. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Prior experience of the patients receiving physical examination by medical students from other departments, and prior experience of the patients receiving pelvic examination performed by medical students significantly increased the rate of acceptance. These findings are consistent with those of Ghobain et al. (2016) who reported that a positive prior experience with a medical student was significantly related to giving medical students permission to perform a physical examination. This can be explained by the fact that these patients were already aware of the medical student involvement in performing physical examinations. Therefore, they are more likely to accept medical student participation in subsequent Ob-Gyn consultations. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">One interesting finding from our study was the positive patient receptivity of medical students acting as observers during pelvic examination. Patients in approximately 70% of the acceptor group allowed other medical students to observe the examination process. Remarkably, 53.6% in the non-acceptor group was comfortable with medical students observing a pelvic examination performed by medical instructor. This would imply that even if students cannot perform pelvic examinations, they can still gain clinical knowledge through observation, and clinical instructors can take advantage of this valuable opportunity to educate their students. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Other major concern of patients is the requirement for students to obtain permission before participating in any procedures. The majority of the participants prefer that medical instructors be in charge of obtaining patient permission to allow students to perform physical examinations on their behalf. This tendency may lead to a higher rate of acceptance of student participation. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The characteristics and performance of the medical students in our study had a significant impact on patients\u2019 decision. The external part of the female reproductive organ is a sensitive and the most private area for every woman, and patients would only allow medical students who practice good hygiene and cleanliness to participate in the examination. Furthermore, the appropriate manner and demeanour, including respectfulness and politeness toward patients, and trustworthiness of the medical students during the clinical procedure may increase the patients\u2019 receptivity of medical students to conduct pelvic examination. Professional appearance reflecting cultural backgrounds also impacts patient preference and acceptance; therefore, medical students should dress properly (Aljoudi et al., 2016).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Several studies, including ours, found that participants felt more at ease with female students than with male students (Salah et al., 2015; Subki et al., 2018). <\/span>Chang et al. (2010) reported<span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">that male students were refused by patients to participate in clinical interviews and physical examinations, including pelvic examinations. In a study conducted at Taibah University in India (Shetty et al., 2021), women significantly preferred female students during abdominal and genital examinations. <\/span>As a result, it is difficult for obstetrics and gynaecology educators to consider methods of encouraging patients to accept participation of medical students, regardless of their genders.<span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Patients&#8217; positive attitudes toward medical students&#8217; participation contributed to clinical teaching, which is an important process for professional development. The patients agreed that they would receive more accurate and comprehensive treatment if they had two pelvic examinations. These details are consistent with the findings of a study conducted by Rizk et al. (2002), which revealed that 69.7% of the participants were willing to contribute to the education of students.<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">Most participants <\/span><span lang=\"EN-GB\">were satisfied with the overall service because they were well informed about their care by the health care team and were actively involved in the treatment decision-making process<\/span><span lang=\"EN-GB\">. Like other literature (Nicum &amp; Karoo, 1998), medical students also provided patients with useful medical information and support. Furthermore, patients strongly supported the idea that real patient encounters and practices under clinical supervision are more effective methods for improving student\u2019s clinical skills than just mere observation or skill laboratory practice (Subki et al., 2018). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Patients&#8217; main reasons for refusing medical students&#8217; participation in pelvic examination were concerns about breaching their confidentiality and privacy, which were similar to a study conducted in London. According to the findings, the common reasons for patients\u2019 uneasiness with participation of the medical students were related to privacy, receiving lower standard of care, examinations, lack of control over the student\u2019s level of involvement, and a longer consultation time (Ryder et al<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-GB\">, 2005). The participants in our study were also concerned about taking a longer than usual routine visit. Not only applicable in Ob-Gyn department, patients\u2019 perceptions of students\u2019 professionalism and respect for privacy were significantly related to the acceptance of medical students\u2019 participation in surgical ward (Ghobain et al., 2016). Thus, all medical students must be informed about the doctor-patient relationship and the importance of maintaining patient confidentiality. Medical instructors must inform and reassure patients about their confidentiality. Before participating in any clinical teachings, medical instructors should explain to students their roles and responsibilities. To minimise patients&#8217; feeling of discomfort, these roles and responsibilities should be conveyed and explained to them before asking for their approval.<span style=\"text-decoration: line-through\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">This paper has highlighted the significance of patients\u2019 attitudes toward medical students\u2019 manner and demeanor, which greatly influences patients\u2019 decision-making process.\u00a0 However, some limitations should be considered, such as the fact that all participants were Thai, and that the study was carried out in one of the Southeast Asia countries where data on the attitudes of female patients had not been thoroughly investigated. Since socio-demographic factors and cultural issues vary across Southeast Asia, the results of this research only represent the characteristics of the Thai population and not the entire region. Additionally, this cross-sectional study could not establish the reasons for patients&#8217; negative attitudes toward student involvement in pelvic examination. Therefore, it is suggested that future research use in-depth interview methodology to gather more information from both the acceptor and non-acceptor groups. <i><u><\/u><\/i><\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><span lang=\"AR-SA\" dir=\"RTL\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Most of patients agreed to medical students participating in pelvic examinations and preferred medical instructors to be the persons to ask patients for permission. Essentially, patients\u2019 confidentiality and privacy must always <\/span><span lang=\"EN-US\">be safeguarded. The performance of medical students, and their observance of patient privacy and confidentiality are crucial factors in gaining the patient\u2019s approval.<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-GB\">Furthermore, the gender of the medical student influences the patient\u2019s acceptance and comfort level in student\u2019s involvement. Clinical instructors must effectively convince patients in gynaecology department to allow male medical students to perform gynaecologic procedures. <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Nisakorn Deesaen,<sup> <\/sup>Punyanuch Phonngoenchai, and Kongpop Sutantikorn<\/span><span lang=\"EN-GB\"> contributed to the literature review, concept development, questionaire design, data collection, data analysis, and manuscript finalisation. <\/span><span lang=\"EN-US\">Sakchai Chaiyamahapruk was involved in the study design<\/span><span lang=\"EN-GB\">, data analysis, and manuscript finalisation. <\/span><span lang=\"EN-US\">Patcharada Amatyakul <\/span><span lang=\"EN-GB\">contributed to the literature review, concept development,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">study design<\/span><span lang=\"EN-GB\">, data analysis, and manuscript writing and finalisation. <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Ethical approval for this study was obtained from the Naresuan University Institutional Review Board, Naresuan University, Thailand (Ethics approval number<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">IRB 0653\/60<\/span><span lang=\"EN-GB\">).<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The data that support the findings of this study are publicly available in <\/span><span lang=\"EN-US\">Open Science Framework<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-GB\">repository, <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68\">http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68<\/a>.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The authors would like to express their gratitude to the nurses at the out-patient unit of the Department of Obstetrics and Gynaecology, Naresuan University Hospital, for their help in distributing and collecting questionnaires from the patients.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This research received no specific grant from any funding agency.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The authors declare no conflict of interest.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\">Aljoudi, S. B., Alsolami, S. S., Farahat, F. M., Alsaywid, B., &amp; Abuznadah, W. (2016). Patients&#8217; attitudes towards the participation of medical students in clinical examination and care in Western Saudi Arabia. <i>Journal of Family and Community Medicine, 23<\/i>(3), 172\u2011178. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.4103\/2230-8229.189133\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.4103\/2230-8229.189133<\/a><\/span><span><span lang=\"EN-US\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Amatyakul, P. (2021). <i>Proposal for patients\u2019 attitude and factors influencing the acceptance of medical students\u2019 participation in pelvic examination.<\/i> <\/span><span lang=\"EN-US\">[Data set]. Open Science Framework. <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68%20\">http:\/\/doi.org\/10.17605\/OSF.IO\/HBV68<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\">Anfinan, N., Alghunaim, N., Boker, A., Hussain, A., Almarstani, A., Basalamah, H., Sait, H., Arif, R., &amp; Sait, K. (2014). Obstetric and gynecologic patients\u2019 attitudes and perceptions toward medical students in Saudi Arabia. <i>Oman Medical Journal, 29<\/i>(2), 106-109. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.5001\/omj.2014.26\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.5001\/omj.2014.26<\/a><\/span><u><\/u><\/p>\r\n<p style=\"text-align: justify\">Bloomfield, H. E., Olson, A., Greer, N., Cantor, A., MacDonald, R., Rutks, I., &amp; Wilt, T. J. (2014). Screening pelvic examinations in asymptomatic, average-risk adult women: An evidence report for a clinical practice guideline from the American College of Physicians. <i>Annals of Internal Medicine, 161<\/i>(1), 46\u201353. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.7326\/M13-2881\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.7326\/M13-2881<\/a><\/span><\/p>\r\n<p style=\"text-align: justify\">Chang, J. C., Odrobina, M. R., &amp; McIntyre-Seltman, K.<span lang=\"EN-US\"> (<\/span>2010). The effect of student gender on the obstetrics and gynecology clerkship experience. <i>Journal of Women\u2019s Health, 19<\/i>(1), 87-92. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1089\/jwh.2009.1357\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.1089\/jwh.2009.1357<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Fortier, A. M., Hahn, P. M., Trueman, J., &amp; Reid, R. L. (2006). The acceptance of medical students by women with gynaecology appointments. <i>Journal of Obstetrics and Gynaecology Canada, 28<\/i>(6), 526-530.<span> <\/span><\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/S1701-2163(16)32179-X\">https:\/\/doi.org\/10.1016\/S1701-2163(16)32179-X<\/a><\/span><span><\/span><\/p>\r\n<p style=\"text-align: justify\">Ghobain, M. A., Alghamdi, A., Arab, A., Alaem, N., Aldress, T., &amp; Ruhyiem, M.<span lang=\"EN-US\"> (2016). <\/span>Patients\u2019 perceptions towards the participation of medical students in their care. <i>Sultan Qaboos University Medical Journal, 16<\/i>(2), 224\u2013229. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.18295\/squmj.2016.16.02.014\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.18295\/squmj.2016.16.02.014<\/a><\/span><span><span lang=\"EN-US\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Hartz, M. B., &amp; Beal, J. R. (2000). Patients\u2019 attitudes and comfort levels regarding medical students\u2019 involvement in Obstetrics\u2013Gynecology outpatient clinics. <i>Academic Medicine, 75<\/i>(10), 1010-1014. <\/span><a href=\"https:\/\/doi.org\/10.1097\/00001888-200010000-00018\u00a0\">https:\/\/doi.org\/<span lang=\"EN-US\">10.1097\/00001888-200010000-00018<\/span><span lang=\"EN-US\">\u00a0<\/span><\/a><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\">McLean, M., Al Ahbabi, S., Al Ameri, M., Al Mansoori, M., Al Yahyaei, F., &amp; Bernsen, R. (2010). Muslim women and medical students in the clinical encounter. <i>Medical Education, 44<\/i>(3), 306-315. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2923.2009.03599.x.\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.1111\/j.1365-2923.2009.03599.x.<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Nicum, R., &amp; Karoo, R. (1998). Expectations and opinions of pregnant women about medical students being involved in care at the time of delivery. <i>Medical Education, 32<\/i>(3), 320-324. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1046\/j.1365-2923.1998.00205.x.\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.1046\/j.1365-2923.1998.00205.x.<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\">Rizk, D. E. E., Al-Shebah, A., El-Zubeir, M. A., Thomas, L. B., Hassan, M. Y., &amp; Ezimokhai, M. (2002). Women\u2019s perceptions of and experiences with medical student involvement in outpatient obstetric and gynecologic care in the United Arab Emirates. <i>American Journal of Obstetrics and Gynecololgy, 187<\/i>(4), 1091-1100. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1067\/mob.2002.126284.\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.1067\/mob.2002.126284.<\/a><\/span><u><span lang=\"EN-US\"><\/span><\/u><\/p>\r\n<p style=\"text-align: justify\">Ryder, N., Ivens, D., &amp; Sabin, C. (2005). The attitude of patients towards medical students in a sexual health clinic. <i>Sexually Transmitted Infection, 81<\/i>(5), 437\u2013439. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1136\/sti.2004.014332.\"><span lang=\"EN-SG\">https:\/\/doi.org\/10.1136\/sti.2004.014332.<\/span><\/a><\/span><\/p>\r\n<p style=\"text-align: justify\">Salah, A. B., Mhamdi, S. E., Bouanene, I., Sriha, A., &amp; Soltani, M. (2015). Patients\u2019 attitude towards bedside teaching in Tunisia. <i>International Journal of Medical Education, 6, <\/i>201-207. <span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.5116\/ijme.5669.ea24.\"><span lang=\"EN-SG\">https:\/\/doi.org\/10.5116\/ijme.5669.ea24.<\/span><\/a><\/span><u><\/u><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Shetty, P. A., Magazine, R., <\/span>&amp; <span lang=\"EN-US\">Chogtu, B. (2021). Patient outlook on bedside teaching in a medical school. <i>Journal of Taibah University Medical Sciences, 16<\/i>(1), 50-56. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.jtumed.2020.10.002\">https:\/\/doi.org\/10.1016\/j.jtumed.2020.10.002<\/a><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Subki,<\/span><span lang=\"EN-GB\"> <\/span><span lang=\"EN-US\">A. H.<\/span><span lang=\"EN-GB\">, Algethami, M. R., Addas, F. A., Alnefaie, M. N., Hindi, M. M., &amp; Abduljabbar, H. S. (2018). Women\u2019s perception and attitude to medical students\u2019 participation in obstetrics and gynecology care. <i>Saudi Medical Journal<\/i>, <i>39<\/i>(9), 902-909.<\/span><span lang=\"EN-US\">\u00a0 <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.15537\/smj.2018.9.22668\"><span lang=\"EN-SG\">https:\/\/doi.org\/<\/span>10.15537\/smj.2018.9.22668<\/a><\/span><span><span lang=\"EN-US\"><\/span><\/span><\/p>\r\n<p style=\"text-align: justify\">Teunissen, P. W. (2018).<span lang=\"EN-US\"> An inconvenient discussion. <i>Medical education, 52<\/i>(11)<i>,<\/i> 1104-1110. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.13689\">https:\/\/doi.org\/10.1111\/medu.13689<\/a><\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><span lang=\"EN-NZ\"><span lang=\"EN-AU\">*<span lang=\"EN-GB\">Patcharada Amatyakul<\/span><br \/>\r\n<span lang=\"EN-GB\">Department of Obstetrics and Gynaecology,<\/span><br \/>\r\n<\/span><\/span><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><span lang=\"EN-GB\">Faculty of Medicine, Naresuan University,<\/span><br \/>\r\n<\/span><\/span><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><span lang=\"EN-GB\">99 Thaphoe District, Muang,<\/span><br \/>\r\n<span lang=\"EN-GB\">Phitsanulok, 65000 Thailand<\/span><br \/>\r\n<\/span><\/span><span lang=\"EN-NZ\"><span lang=\"EN-AU\"><span lang=\"EN-GB\">Tel: 66-86-397-3455<\/span><br \/>\r\n<span lang=\"EN-GB\">Email: pamatyakul@hotmail.com<\/span><br \/>\r\n<\/span><\/span><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":10,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61870],"class_list":["post-71219","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-7-number-1-january-2022"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - 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