Supporting clinical medical education with primary care experience is an invaluable component in medical students' education. Attitudes of the patient toward being a part of medical education are a very important factor in education quality. In recent years, services have changed from focus on care of hospital inpatients to ambulatory patients. This caused changes in the format of medical education. Patients' attitudes were very positive with participation of medical students in the visits at internal medicine, surgery, and dermatology clinics ^(1,2,3).

Family Medicine, which forms a big part of medical education, and which has a great role in giving the philosophy of general medicine to the students, is one of the areas where the patient-doctor communication is most put into practice (^4,5,6,7). Observations showed that medical students are accepted generally by the patients ^(3,8,9,10). However, advantages and disadvantages of participation of students to the examinations were not clear.

Positive communications between the patients and students have important effects on determining the expectations of the patients ⁽¹¹⁾. At the same time, training well-educated primary care doctors also has a big importance on constructing the organisation of changing health services and providing good quality healthcare ^(2,12,13). This study is designed to observe the attitudes of patients toward participation of senior medical students in their examinations.

Uludag University Faculty of Medicine is a university hospital that serves the Marmara Region of Turkey. This study was done at Fethiye Family Medical Centre, where senior medical students do the patient examinations, and it is located in the main building of Uludag University Department of Family Medicine.

The patients who applied to Uludag University Faculty of Medicine Department of Family Medicine and who were seen by students' were included in this study. The patients whose examinations were completed were asked to voluntarily fill out the questionnaire forms anonymously. Students examined all the patients during their practice. The questionnaire forms consist of 13 questions that contain demographic information, education status, and their opinions about participation of medical students in the examination period.

Senior medical students do a 4-week family medicine rotation, examining the patients before the responsible lecturer. First, medical students introduce themselves to the patient, take the medical history and before the responsible doctor arrives, they finish the examination of the patient. Then, students collect all findings, present them to the responsible lecturer and finally they end the visit together by evaluating the patients.
Statistical analyses, double frequency charts, comparison of the distribution of categorized answers were observed with ki-square. Five pointed Likert scale was used in the questionnaire form and the highest point was given to the most accepted (1 being strongly disagree, 5 being strongly agree). Variation analyses were made to compare the average of the answers to the demographic variables and one-way ANNOVA statistics were made to show the harmony in variables. SPSS 9.0 program was used at all analyses.

A hundred and eighty five people were included in this study. Demographic data are presented on Table 1. 98.2% of the patients stated that the patient examination is a necessity, 1.7% of the patients were undecided, only 0.1% of the patients did not answer this question. Opinions of the patients about student participation in their examinations are summarized in Table 2.

92.1% of the patients stated that participation of the students in their examination was helpful for them, 5.6% of the patients were undecided, and 2.3% of the patients responded that this practice was not useful.

84.1% of the patients felt confident about the participation of the students in the examinations, 9.1% of the patients expressed that they had no idea, and 6.8% of the patients expressed that they did not feel confident in the examinations.

76.6% of our patients expressed that they were not disturbed by the participation of the students, 78.4% of the patients expressed that participation of the students to the examinations did not cause waste of time, and 72.6% of them expressed that this participation did not prevent them from explaining their illnesses; they also expressed that they could easily explain their illnesses.

For the internal reliability of analysed data, Cronbach Alpha index was calculated. Cronbach Alpha, which is a reliability coefficient, was found approximately 80.0% (0.7972). At the same time, it can be said that internal consistency of data is very good because there was not any negative relationship between total correlations and any variables, or total correlation between variables was not very low.

According to the results of ANOVA, there was a meaningful difference between the answers of young and old patients about the idea of patient examination being necessary or unnecessary in medical education. When the ages of the patients increase, response to this subject became more positive (p=.014). Older patients received the highest score (4.857). Middle-aged (30-60) patients (4.796), young (<30) patients received less (4.581) scores. It was also the same for the people who thought that student examinations were helpful (p=.031).

It was noted that gender, which was one of the demographic data, was the most distinctive point regarding the idea of examination of the patients by students as being a necessity in medical education (p=.025). 82.2% of women and 65.0% of men had very positive thoughts about this subject.

When we consider the marital status of the patients, 79.6% of the married patients, 62.5% of the single patients had the thought of practical education being a necessity, and this was found meaningful (p=.042).

The confidence in being examined by students is much higher in patients with less education (p=.033). The thoughts about student examinations of patients being useless is very common in patients with less education (p=.031). This seeming contradiction between these two results may be caused by their low education level. In addition, the effect of education level on explaining illnesses, while students were participating in their examinations, is clear in patients with less education (p=.013).

Before medical students graduate, the increased opportunity for communication with patients, and the increased number of interviews and examinations, is a golden opportunity for these students who are going to start their medical professions in the near future. Positive feedback from the examined patients to students is also very motivating for students.

In our study, a large percentage of our patients found the participation of students in clinical examinations very helpful. The percentage of satisfied patients who were examined by the students is 82.0%. 92.1% of the patients found students' examination useful for themselves and 84.1% of the patients found the examination dependable. This shows that our students have been successful in patient communication.
At the same time, 98.2% of the patients agreed with the concept of patient examination by the students, is a necessity during medical education, 88.8% of the patients agreed with the idea that this kind of education is very useful for the students. 76.6% of the patients were not disturbed by being examined by the students, 78.4% of the patients believe that this was not a waste of time; only 20.9% of patients could not explain their illnesses. This shows that patients are very pleased with the participation of the students in these visits ⁽³⁾. Also, it shows that the patients are ready for this kind of service to help students' education.

When we compare the demographic data of our patients and patients' attitudes, we can conclude that patient attitudes about this kind of education as a necessity in medical education and the increase in opportunity for doing the examinations as helpful, is directly proportional with age. Women, compared to men, believe more in the necessity of practical education, in medical education. Married patients, compared to single patients, also believe in it more. When we consider the education levels, the examination's usefulness seems to increase with decrease in education level. However, the percentage of difficulty in explaining their illnesses and the thought of examination being useless, increased. Our patients with less education may not be able to express their thoughts about this subject totally.

In our study, attitudes of lecturers toward the participation of students in visits were not considered. This could have changed the interaction between the patients and the students, because in our clinic, lecturers evaluate the students.

In the light of data provided by this study, we can say that communication between the patients and the students is satisfactory ^(5,8,10). The patients felt positive about participation of the students in their examinations. Satisfaction of the elderly, married, women, and patients with less education toward students' services is very high.
In the Family Medicine rotation, which is the last part, shaping medical students' education, working at the outpatient clinics is invaluable. Patients whose positive attitudes toward students are going to make this education best are very important teachers in this period. This study supports that patients should be more active in medical students' education.

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