Article

Influence of clerkship experiences on clinical competence

Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands
Medical Education (Impact Factor: 3.62). 06/2006; 40(5):450-8. DOI: 10.1111/j.1365-2929.2006.02447.x
Source: PubMed

ABSTRACT Clerkship experiences are considered crucial for the development of clinical competence. Yet whether there is a direct relationship between the nature and volume of patient encounters and learning outcomes is far from clear. Some evidence in the literature points towards the importance of clinical supervision on student learning, but the relationship between clinical supervision, patient encounters and student competence remains unclear.
This study aimed firstly to determine the variation in students' clinical experiences within and across sites; secondly, to identify the causes of this variation, and thirdly, to investigate the consequences of this variation on students' competence.
Clerkship students at 12 hospital sites recorded their patient encounters in logbooks. Site characteristics that might influence the variation in patient encounters were collected. Student competence was determined by 3 independent indicators: a practical end-of-clerkship examination; a theoretical end-of-clerkship examination, and an evaluation of professional performance. A model was developed to test the available clerkship data using structural equation modelling (SEM) software.
Analysis of the logbooks revealed a large variation in the number of patients encountered by students. The average length of patient stay, number of patients admitted, and quality of supervision accounted partly for this variation. An increased number of patient encounters did not directly lead to improved competence. Quality of supervision turned out to be crucially important because it directly impacted student learning and also positively influenced the number of patient encounters.
Monitoring the effectiveness of clerkship by merely asking students to keep a tally of the problems and diseases they encounter, without paying attention to the quality of supervision, does not contribute towards improving student learning.

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    • "Eight studies compared the patient mix of training sites and their contribution to learning. In three of these studies, similar sites were compared (Chatenay et al. 1996; Wimmers et al. 2006a; Yu et al. 2011), three others compared academic vs. nonacademic sites (Schwiebert et al. 1993; McLeod et al. 1997; Nomura et al. 2008) and two compared inpatients and outpatients (Jacobson et al. 1998; Duke et al. 2011). Four studies evaluated the learning effects of an intervention: the introduction of a rotation (Gruppen et al. 1993), a skill-training programme (Boots et al. 2008), identification of 10 preselected complaints (Lampe et al. 2008) and a new internship (Nomura et al. 2008). "
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    • "However, the assessment of its impact on their performance and their ability to manage the patient yielded contradictory results and needs further research. Other studies suggested that the number of real patient cases encountered is not necessarily a predictor of acquired clinical competence, if this experience is not associated with highquality supervision and feedback (Ericsson 2004; Wimmers et al. 2006; Fung et al. 2007). Although the clerkship tradition is well established, some concerns are raised because of the reduced availability of "
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    • "Nevertheless, we recognize that clerkship grades are influenced by a multitude of factors and may not be the most sensitive metrics for the impact of clinical experience. As shown in an elegant analysis, Wimmers et al. (2006) demonstrated that while the number of patient encounters had a statistically significant (albeit modest) correlation with clinical evaluations, quality of supervision had a more direct effect on end-of-year exam scores. "
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