To the Editor: I note with interest Australian medical students’ difficulties in gaining access to patients, as documented by several authors in recent months.1-3 There is an alternative explanation for this paucity of access, and that is the culture in Australian teaching hospitals.

I graduated from the University of Otago Dunedin Medical School in New Zealand 9 years ago, and had a somewhat different experience. The hospitals attached to the Dunedin Medical School were the equivalent of one medium-sized acute hospital in Australia, one rehabilitation hospital, and a small peripheral regional hospital. These facilities taught up to 200 clinical medical students — a high student-to-patient ratio. However, we did not face the barriers that Australian students face in gaining access to patients, and so still had a world-class medical education.

The system in Otago differed from that in Australia in several ways. If a patient was having an investigation, we accompanied them. Likewise, if they were seeing a staff member, we would often stay. There was a culture where every patient admitted to hospital expected to see a medical student. We approached the patients directly to ask permission to see them, rather than being turned away by nursing staff. Consequently, in non-obstetric patients, I encountered only one refusal to see me in my clinical years, and this was after I had started taking a history and asked about tranquilliser use in too much detail! We also did not wait to see only patients who were ideal teaching cases — patients who speak English, do not have dementia, are not unwell, are not busy, and who have a particularly interesting condition are rare anywhere. If a patient had dementia or was unwell we familiarised ourselves with their history, then saw the patient over the course of several days. If there were visitors, we asked about an appropriate time to come back. We saw all routine cases, as these reflect the real workload of doctors. By comparison, in my years as a resident and registrar in Australia, I have seen very few medical students, and have seen many teaching and learning opportunities pass by.

In conclusion, we need to examine the role of medical students closely, and look at ways to facilitate their access to existing patients. There is something to be learned from all patients admitted to hospital. The culture of teaching hospitals and the expectations of students, staff and patients should reflect this fact.