[Show abstract][Hide abstract] ABSTRACT:
The decentralization of clinical teaching networks over the past decade
calls for a systematic way to record the case-mix of patients, the severity
of diseases, and the diagnostic procedures that medical students encounter
in clinical clerkships.Objective
To demonstrate a system that documents medical students' clinical experiences
across clerkships.Design and Settings
Evaluation of a method for recording student-patient clinical encounters
using a pocket-sized computer-read patient encounter card at a US university
hospital and its 16 teaching affiliates during academic years 1997-1998 through
A total of 647 third-year medical students who completed patient encounter
cards in 3 clerkships: family medicine, pediatrics, and internal medicine.Main Outcome Measures
Number of patient encounters, principal and secondary diagnoses, severity
of diseases, and diagnostic procedures as recorded on patient encounter cards;
concordance of patient encounter card data with medical records.Results
Students completed 86 011 patient encounter cards: 48 367
cards by 582 students in family medicine, 22 604 cards by 469 students
in pediatrics, and 15 040 cards by 531 students in internal medicine.
Significant differences were found in students' case-mix of patients, the
level of disease severity, and the number of diagnostic procedures performed
across the 3 clerkships. Stability of the findings within each clerkship across
3 academic years and the 77% concordance of students' reports of principal
diagnosis with faculty's confirmation of diagnosis support the reliability
and validity of the findings.Conclusions
An instrument that facilitates students' documentation of clinical experiences
can provide data on important differences among students' clerkship experiences.
Data from this instrument can be used to assess the nature of students' clinical
Figures in this Article
Medical students are exposed to an array of clinical experiences in
hospital and ambulatory settings during their clinical clerkships. Monitoring
these experiences is essential to ensure that students acquire an appropriate
mix of clinical experiences. Attempts made over the last 25 years1 to document the clinical experiences of students have
used such recording devices as casebooks,2
optical scan forms,9- 10 handheld
or palmtop computers,9,11 and
pocket-sized encounter cards.12 These studies
have been limited to small samples in isolated clerkships over brief time
periods3,8- 9,13- 24
and they have largely ignored the severity of illness.
Dramatic changes in the financing and delivery of health care during
the past decade have altered the clinical environments in which medical education
As medical education becomes increasingly decentralized, clinical education
has partially shifted from a tertiary inpatient setting to community-based
and ambulatory sites.3,29- 31
In this kind of educational environment, it is still essential that medical
students encounter a variety of disease entities and are given the opportunity
to perform basic diagnostic and therapeutic maneuvers.
Effective curriculum management requires a valid and reliable system
to document the range and type of students' clinical experiences. Only by
monitoring students' opportunities for clinical encounters with a diverse
mix of patients can informed decisions be made regarding the appropriateness
of a teaching network, training sites, and the balance between inpatient and
ambulatory activities. As medical schools review their learning objectives
to better define the competencies needed by future physicians,32
it will become even more important to document the clinical educational opportunities
offered to medical students.
We investigated the applications of a new system to document key aspects
of the clinical experiences of third-year medical students in 3 clerkships
(family medicine, pediatrics, and internal medicine) at Jefferson Medical
College, Philadelphia, Pa. We provide evidence of validity and reliability,
as well as representative examples of the information produced by the system.
JAMA The Journal of the American Medical Association 286(9):1035-1040. DOI:10.1001/jama.286.9.1035 · 30.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT:
The psychiatric clerkship is the educational center of the psychiatric curriculum and is a powerful influence in recruitment into psychiatry. Clerkships remain inpatient-based, although effective treatments and changes in reimbursement have moved the practice of psychiatry out of hospitals and into ambulatory settings. Despite dissatisfaction with inpatient teaching, psychiatry has lagged behind other specialties in creating outpatient teaching venues.
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