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Open Access Highly Accessed Research article

Evaluating the quality of interaction between medical students and nurses in a large teaching hospital

Gregory J Nadolski1, Mary A Bell1, Barbara B Brewer2, Richard M Frankel3, Herbert E Cushing1 and James J Brokaw1*

Author Affiliations

1 Office of Medical Student Affairs, Indiana University School of Medicine, 635 Barnhill Drive, MS-164, Indianapolis, Indiana 46202-5120, USA

2 Office of Professional Practice, John C Lincoln North Mountain Hospital, 250 East Dunlap Avenue, Phoenix, Arizona 85020, USA

3 The Regenstrief Institute, Indiana University School of Medicine, 1050 Wishard Boulevard, RG-6, Indianapolis, Indiana 46202-2872, USA

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BMC Medical Education 2006, 6:23  doi:10.1186/1472-6920-6-23

Published: 25 April 2006



Effective health care depends on multidisciplinary collaboration and teamwork, yet little is known about how well medical students and nurses interact in the hospital environment, where physicians-in-training acquire their first experiences as members of the health care team. The objective of this study was to evaluate the quality of interaction between third-year medical students and nurses during clinical rotations.


We surveyed 268 Indiana University medical students and 175 nurses who worked at Indiana University Hospital, the School's chief clinical training site. The students had just completed their third year of training. The survey instrument consisted of 7 items that measured "relational coordination" among members of the health care team, and 9 items that measured psychological distress.


Sixty-eight medical students (25.4%) and 99 nurses (56.6%) completed the survey. The relational coordination score (ranked 1 to 5, low to high), which provides an overall measure of interaction quality, showed that medical students interacted with residents the best (4.16) and with nurses the worst (2.98; p < 0.01). Conversely, nurses interacted with other nurses the best (4.36) and with medical students the worst (2.68; p < 0.01). Regarding measures of psychological distress (ranked 0 to 4, low to high), the interpersonal sensitivity score of medical students (1.56) was significantly greater than that of nurses (1.03; p < 0.01), whereas the hostility score of nurses (0.59) was significantly greater than that of medical students (0.39; p < 0.01).


The quality of interaction between medical students and nurses during third-year clinical rotations is poor, which suggests that medical students are not receiving the sorts of educational experiences that promote optimal physician-nurse collaboration. Medical students and nurses experience different levels of psychological distress, which may adversely impact the quality of their interaction.