Enrollees' perceptions of participating in the education of medical students at an academically affiliated HMO

Purpose. Little is known about how enrollees in health maintenance organiza tions (HMOs) perceive the benefits and risks of participating in the educat ion of medical students. This case study elicited the views of enrollees of one academically affiliated HMO about the education of medical students. Method. Data from focus groups were used to design two questionnaires that were mailed to 488 adult patients and 298 parents or guardians of pediatric patients. A sample of non-respondents was followed up by telephone. Descri ptive analyses were performed on the responses to the questionnaires. Results. Response rates were 46% (adult) and 43% (parent or guardian). More than 75% of the respondents thought the HMO should be involved in teaching , most because teaching contributes to the training of better doctors and i ncreases the skills of teacher-clinicians. Of those who responded, 28% of a dults were concerned about risks to confidentiality and 18% were concerned about increased costs for enrollees. Nearly 50% of adults would be uncomfor table with students participating in visits involving "internal" examinatio ns or emotional problems. Of those who responded, 56% of adults and 33% of parents or guardians were uncomfortable about a student's conducting an uns upervised history and physical examination. A total of 52% of adults prefer red that the preceptor and student discuss their case in their presence Res pondents who had seen students previously were more comfortable with studen t activities associated with their care. Conclusions. The respondents thought the HMO should be involved in teaching , but they had specific concerns about the effects of student participation . Educators in other settings may wish to explore these concerns among thei r patient populations and develop policies to maximize the "enrollee-friend liness" of medical education in HMOs. While the study provides a first look at how enrollees at one HMO viewed participation in medical students' educ ation, further research is needed at HMOs elsewhere to determine the repres entativeness of the study's findings.