Raw Data

<strong>Recruitment</strong> Inclusion criteria was only limited to inpatient adults and young people over 16 years of age who were able to comprehend the study information. On paediatric wards, consent was gained from a guardian, and the guardian’s response to the questionnaire recorded. Excluded inpatients were those admitted with active COVID-19 infection, those on the intensive care unit (due to the level of care needs), those in the emergency department (as these patients were largely not admitted), and patients who were unable to comprehend the study information. Patients were not approached if their attending medical team felt they had significant acute or chronic cognitive impairment. Data collection was completed between 18/02/2022 and 16/03/2022 inclusive at University Hospitals Plymouth, UK. Eligible patients were approached on these wards within the data collection period (n=234) were invited to participate, of which 200 were surveyed (or their guardians in the case of 17 paediatric patients). During their 3rd and 4th years of studies, medical students at University of Plymouth Faculty of Medicine and Dentistry have 60 clinical placement weeks. 37 of these involve students talking to and/or examining in-patients. The relative number of weeks spent in medical/ surgical/ obstetric/ paediatric/ mental health specialities was calculated as a fraction of the 37 week total and used to guide the number of participants recruited from different wards. This was done with the expectation that patients within different specialities would have different demographics and perception of risk, and aimed to ensure results are generally applicable for medical student training. <strong>Questionnaire Design</strong> There were no appropriate or validated pre-existing questionnaires on literature search, therefore an original questionnaire was created. The seventeen questions were designed as statements. Responses were collected via a combination of modified Likert scale and multiple-choice questions (Appendix). The opening question ‘<em>I am happy to talk with a medical student and allow them to examine me’</em> formed our pre-intervention measurement. The following two questions covered the participant’s COVID-19 history (vaccinations and prior infections), with a further nine questions covering areas which we felt might influence participant willingness to see medical students. These questions, our interventional questionnaire, aimed to prompt reflection by participants on the risks of COVID-19 and the benefits of medical student interaction. We then repeated the opening question as a post-intervention measurement to explore the effect of our intervention on willingness to engage in medical education. The final four questions were intended to ascertain what measures would minimise participants perceived risk of COVID-19 and therefore make participants feel more comfortable about being seen by a medical student, with regards to guidance at time of data collection.[10, 11, 12] These included the use of outpatient settings, vaccination and interval LFTs by students, and the use of PPE. <strong>Delivery and Analysis</strong> The survey was hosted online by Online Surveys and administered via tablet devices. Data collection was performed by three junior doctors and two medical students, referred to hereafter as recruiters. The medical students were on clinical placement at the time of questionnaire administration. Informed consent was gained verbally after the recruiter read a standardised opening explanation to the patient and/or guardian. Participants completed the questionnaire independently on a tablet device where able, but to ensure those with sensory impairments were able to complete the questionnaire, some participants were facilitated by recruiters. We recognise this study design is open to volunteer bias, but aimed to address this by minimising exclusion criteria, and maximising patient engagement through facilitation. We aimed to match our criteria to those used when determining which patients should be approached for educational contact with medical students while on ward placements for external validity. Data analysis was performed using the statistics software, R[13]. All variables of interest are categorical and were therefore summarised using frequencies and percentages of non-missing data. A Wilcoxon signed-rank test was used to examine the change in willingness to see medical students between pre- and post-intervention along with the change in willingness between post-intervention and in a hypothetical outpatient clinic. A Wilcoxon rank-sum test was used to compare the pre-intervention willingness of patients to see medical students when provided the questionnaire by a Doctor or by a medical student. A p-value of &lt;0.05 is considered statistically significant and all are two-sided. Patient and Public Involvement The questionnaire content was peer-reviewed by the Patient Experience &amp; Engagement Lead for University Hospitals Plymouth and a patient representative. Their feedback was incorporated into the final version of the questionnaire. Ethical Approval After discussion with the Plymouth Research and Development team, this study did not require ethical approval and was registered with the Clinical Audit Department, University Hospital Plymouth (Reference: CA_2021-22-253) as a Service Evaluation. All patients gave informed consent after explanatory information was given.

<strong>招募</strong> 本研究的纳入标准仅限定为能够理解研究信息、年龄16岁以上的住院成人及青少年。在儿科病房中，需获得监护人的知情同意，并记录监护人对问卷的作答结果。排除标准包括：因活动性新冠病毒感染入院的患者、因护理需求等级较高而入住重症监护病房（Intensive Care Unit, ICU）的患者、急诊科患者（此类患者大多未住院），以及无法理解研究信息的患者。若患者的主管医疗团队认为其存在显著的急性或慢性认知功能障碍，则不会接触该患者。数据收集于2022年2月18日至2022年3月16日（含首尾两日）在英国普利茅斯大学附属医院（University Hospitals Plymouth）完成。在数据收集期间，共联系了符合入组标准的住院患者（n=234）并邀请其参与研究，最终200名患者完成了问卷调研（其中17名儿科患者由监护人代为作答）。普利茅斯大学医学院与牙科学院的医学生在其学习的第三、四年需完成60周的临床实习，其中37周的实习内容为与住院患者沟通或（和）进行体格检查。研究人员将医学生在内科、外科、产科、儿科、精神卫生等专科的实习周数占总37周实习时长的比例，用于指导从不同病房招募的参与者人数。此举旨在考虑到不同专科的患者具有不同的人口学特征与风险感知，进而确保研究结果可普遍适用于医学生临床培训场景。
<strong>问卷设计</strong> 经文献检索未发现合适且经过验证的相关问卷，因此本研究自行编制了原创问卷。问卷共包含17道以陈述形式设计的题目，作答方式采用改良李克特量表（Likert scale）与选择题相结合的形式（详见附录）。首道题目为<em>我愿意与医学生沟通并允许其为我进行体格检查</em>，作为干预前的测量指标。后续两道题目用于调研参与者的新冠病毒感染史（疫苗接种情况与既往感染史），另有9道题目覆盖研究人员认为可能影响参与者愿意接触医学生的相关因素。上述题目构成了本研究的干预性问卷，旨在引导参与者反思新冠病毒感染的风险以及与医学生互动的益处。随后研究人员重复作答首道题目，作为干预后的测量指标，以探究本次干预对参与者参与医学教育意愿的影响。最后四道题目用于明确在数据收集阶段，哪些措施可最大程度降低参与者感知到的新冠感染风险，进而提升其对医学生进行体格检查的接受度[10,11,12]。此类措施包括采用门诊就诊场景、医学生完成疫苗接种及定期快速抗原检测（Lateral Flow Test, LFT），以及个人防护装备（Personal Protective Equipment, PPE）的使用。
<strong>实施与数据分析</strong> 本调研由Online Surveys平台在线托管，并通过平板电脑设备进行发放。数据收集由3名初级医师与2名医学生完成，后续统称为招募人员。本次问卷发放时，该2名医学生正处于临床实习阶段。招募人员首先向患者及（或）监护人宣读标准化的开篇说明，随后获得口头知情同意。具备独立作答能力的患者可自行在平板电脑上完成问卷；为保障存在感官障碍的患者也可完成问卷，部分受试者由招募人员协助完成作答。研究人员意识到本研究设计存在志愿者偏倚的风险，因此通过最小化排除标准、借助协助提升患者参与度的方式来尽量缓解该问题。为提升研究的外部效度，研究人员力求将本研究的入组标准与临床实习中确定可接触医学生开展教育互动的患者标准保持一致。数据分析采用统计软件R[13]完成。所有关注变量均为分类变量，因此采用非缺失数据的频数与百分比进行汇总。本研究采用威尔科克森符号秩检验（Wilcoxon signed-rank test）分析干预前与干预后患者接触医学生意愿的变化，以及干预后意愿与假设门诊场景下意愿的差异；采用威尔科克森秩和检验（Wilcoxon rank-sum test）对比由医师或医学生发放问卷时，患者的干预前接触意愿。本研究将p值<0.05视为具有统计学显著性，且所有检验均为双侧检验。
<strong>患者与公众参与</strong> 问卷内容由英国普利茅斯大学附属医院的患者体验与参与负责人及一名患者代表进行同行评审，其反馈意见已纳入问卷的最终版本。
<strong>伦理批准</strong> 经与普利茅斯研究与开发团队讨论后，本研究无需获得伦理批准，并已在普利茅斯大学附属医院临床审计部门注册为服务评估项目（编号：CA_2021-22-253）。所有患者在获得研究说明后均签署了知情同意书。