Patient satisfaction and willingness as indicators for patient perspectives toward trainee involvement: a systematic review

Medical trainees learn from treating patients. Patients’ refusal of trainees as caregivers influences the types of patients who trainees see and thereby their learning. This is likely to be even more pronounced in ambulatory care facilities, where patients have more say in the choice of doctor. Understanding patients’ perspectives on trainee involvement in their care may provide useful insights into how to enhance their acceptance of trainees. Therefore, we conducted a systematic review of the literature, focussing on patients’ perspectives on trainee involvement in their care and factors affecting these perspectives in the ambulatory care setting. We searched four databases (EMBASE, Medline, ERIC, and PsychInfo) from the start of each database until April 2024, combining keywords for ambulatory care settings, residency, and patient attitudes. Two researchers independently performed the review process. A total of 8735 studies were identified, 38 of which were included. Most studies had a survey design. The mean MERSQI score was 8.7, indicating low quality. Studies have reported various outcomes, of which satisfaction and willingness with trainee involvement are overarching themes. Most studies reported notably high satisfaction rates, often exceeding 90%, and more than 70% of patients reported trainee involvement. However, acceptance rates decline rapidly when tasks or reasons for consultation are more complicated or when patients have long-standing illnesses. Patients were also less satisfied with trainees’ interpersonal competencies than were fully trained doctors. A positive relationship was found between previous treatment by a trainee and patients’ willingness to consult a trainee. Patients generally report high levels of satisfaction and willingness to engage with trainees, particularly in straightforward consultations or when prior contact exists. Nonetheless, lower ratings of trainees’ interpersonal competencies and reduced willingness in complex or chronic cases underscore the need for improved communication training and greater continuity in trainee‒patient interactions.