Discussion
We analysed responses from 2263 patients in GP's waiting rooms regarding their attitudes to and experiences of consultations in general practice with medical students in clinical placement. The majority were positive to consultations involving students, particularly those who had previous experience of this at their GP's practice. These respondents generally reported a positive experience, that they felt safe during the consultation, received the help they needed and would be comfortable meeting the student again.
The proportion of women (62 %) is comparable to figures for GP consultations (20) . The proportion of consultations involving patients aged over 80 years (2.6 %) was lower than in the general population (8.7 %) (20) . One possible explanation is that the questionnaire could only be completed online, and the oldest age groups tend to have lower levels of digital literacy (21) .
In line with previous studies, our respondents largely considered that they contributed to medical students' education by participating in student consultations (6, 11, 12) . The observation that those with prior experience of students were the most positive is also consistent with earlier research (5) . This may be a reflection of good experiences, but it is also possible that those who are most positive are more likely to agree to student consultations.
In a study from 2008 of patients who had agreed to have a student present in consultations, one in five nevertheless stated that they would have preferred to see the doctor alone (11) . We also observed this ambivalence in our study: 18 % of those who reported that it would be acceptable to meet the student again also indicated that they found it difficult to decline when asked to have a consultation with a student instead of their GP.
Among the few publications describing patients' experiences of consultations conducted solely by a student are two Norwegian studies, in which patients provided very positive feedback about the students (9, 10) . Similarly, in a Swedish study from 2008, a large majority reported that they appreciated such consultations (6) . Enabling students to gain experience in dealing with emotional and intimate issues while simultaneously safeguarding patients requires awareness on the part of students as well as clinical supervisors (6, 8) .
To our knowledge, our study is the first to describe patients' perceived sense of safety in student consultations, and the findings are predominantly positive. However, patients presenting with mental health problems, patients from countries outside the Nordic region and those who find it difficult to decline student consultations appear to experience a lower degree of safety than others. This is consistent with previous literature on groups who may be more reluctant to agree to student consultations (7, 12) , and highlights factors that clinical supervisors and students should recognise and take into account.
The results of the study can be used by students when preparing for clinical placements and in their contact with clinical supervisors. They can also be used by universities in their efforts to further develop clinical placements and in dialogue with the authorities. Clinical placements should aim to safeguard patients and students within the learning environment, and a stronger focus on formal competence for clinical supervisors may help to establish a robust framework for supervisors to support both groups.
Strengths and limitations
Strengths and limitations
The strength of this questionnaire study is the large number of respondents and the fact that the study population consisted of patients presenting to their GP for medical care (22) . It is also a strength that the participants had no dependent relationship with the student who invited them to take part. Furthermore, the study is one of few to examine patients' experiences of student consultations in addition to consultations with a student present. This is particularly important as the number of students and duration of clinical placements in primary care is set to increase in the future, and students will also be expected to conduct independent consultations.
The study also has some limitations. The self-selection of students and patients may have introduced selection bias. Since patients were recruited in GPs' waiting rooms, most of their prior experience with students likely involved earlier students. The types of patients and medical issues selected for these student consultations may have influenced patients' experiences of the students. It may also vary whether patients are reporting on independent student consultations or consultations in which the student was observing the GP. Nevertheless, some questions were only posed to patients who recalled the student in the doctor role, and the responses should therefore be interpreted accordingly.
One in four participants reported finding it difficult to decline student consultations, which may have resulted in a selection bias of patients with prior experience of student consultations. Furthermore, there may have been inconsistencies in students' inclusion and recording of data, potentially resulting in underreporting of the number of patients invited and an artificially high response rate. The relatively low response rate also raises questions about the representativeness of our participants. Over 90 % of respondents were from Norway, and experiences of patients from other backgrounds may therefore be underreported.
Conclusion
Conclusion
Clinical placement is an important part of medical students' education, and the patients in our study generally perceived student consultations as positive and safe. Nevertheless, supervisors and students should consider the needs of vulnerable patient groups to ensure that it remains safe to increase the number of students and duration of clinical placements in GP practices.