Perceptions and Attributions of Third-Year Student Struggles in Clerkships: Do Students and Clerkship Directors Agree?

University of California, San Francisco, San Francisco, California, United States
Academic Medicine (Impact Factor: 2.93). 11/2007; 82(10):970-8. DOI: 10.1097/ACM.0b013e31814a4fd5
Source: PubMed


To explore the congruence between students' and clerkship directors' perceptions and attributions of students' struggles during the transition to clerkships.
Focus groups and interviews were conducted with third- and fourth-year medical students and clerkship directors at 10 U.S. medical schools in 2005 and 2006. Schools were selected to represent diverse locations, sizes, and missions. Interviews and focus groups were recorded, transcribed, and analyzed thematically.
Students' struggles included understanding roles and responsibilities, adjusting to clinical cultures, performing clinical skills, learning the logistics of clinical settings, and encountering frequent changes in staff, settings, and content. Clerkship directors recognized students' struggles with roles and responsibilities, performing clinical skills, and adjusting to clinical cultures, but they also focused on students' difficulties applying knowledge to clinical reasoning and engaging in self-directed learning.
Clerkship directors and students recognize many challenges associated with learning and performing in the clerkships. Students' perspectives suggest that these challenges may be more complex than clerkship directors and clinical teachers realize and/or are capable of addressing. The areas in which clerkship directors' and students' perspectives are not congruent point to directions for future research that can guide curricula and teaching strategies.

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    • "Support can include faculty development courses [54], and the provision of the preparatory workshops for students entering the clerkships [55]. Special consideration can be given to expectation management (both of clinical staff and students) [56] and alignment of educational goals to be achieved in the rotations [57]. "
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    ABSTRACT: Hospital clerkships are considered crucial for acquiring competencies such as diagnostic reasoning and clinical skill. The actual learning process in the hospital remains poorly understood. This study investigates how students learn clinical skills in workplaces and factors affecting this. Six focus group sessions with 32 students in Internal Medicine rotation (4-9 students per group; sessions 80-90 minutes). Verbatim transcripts were analysed by emerging themes and coded independently by three researchers followed by constant comparison and axial coding. Students report to learn the systematics of the physical examination, gain agility and become able to recognise pathological signs. The learning process combines working alongside others and working independently with increasing responsibility for patient care. Helpful behaviour includes making findings explicit through patient files or during observation, feedback by abnormal findings and taking initiative. Factors affecting the process negatively include lack of supervision, uncertainty about tasks and expectations, and social context such as hierarchy of learners and perceived learning environment. Although individual student experiences vary greatly between different hospitals, it seems that proactivity and participation are central drivers for learning. These results can improve the quality of existing programmes and help design new ways to learn physical examination skills.
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    ABSTRACT: In a formative evaluation, we were supposed to find whether an innovative program has some merits to be continued or not. We also determined the critical points of the program. The evaluated program was a clinical pre-clerkship curriculum launched for departing to a less stressful medical clerkship. We analyzed the information contained in the students' logbooks. Using Dundee Ready Education Environment Measure standardized questionnaire, we also assessed the students' perception of learning environment within six clinical departments. Totally, 64% of expected patient contacts, and teaching of more than 71% of required skills at 4 departments were carried out and students had more positive than negative perspective of their learning environments. The evaluand is a worthwhile program to be continued, though it needs some considerations for improvement.
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    • "However, due to limited clinical exposure to patients, it is not only challenging for medical students in Phase 1 Medicine (pre-clinical years) to systematically learn and develop clinical skills appropriate to working in a clinical environment, but also to be able to apply these skills when they move onto their clinical rotations in Phase 2 Medicine (clinical years). The transition from preclinical to clinical training is huge for the students and several studies have documented that the transition is quite stressful [4]. "
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    ABSTRACT: Background: Simulation training has potential in developing clinical skills in pre-clinical medical students, but there is little evidence on its effectiveness. Methods: Twenty four first year graduate entry preclinical medical students participated in this crossover study. They were divided into two groups, one performed chest examination on each other and the other used SimMan. The groups then crossed over. A pretest, midtest and post-test was conducted in which the students answered the same questionnaire with ten questions on knowledge, and confidence levels rated using a 5 point Likert scale. They were assessed formatively using the OSCE marking scheme. At the end of the session, 23 students completed a feedback questionnaire. Data was analyzed using one-way ANOVA and independent t-test. Results: When the two groups were compared, there was no significant difference in the pretest and the post-test scores on knowledge questions whereas the midtest scores increased significantly (P< 0.001) with the group using SimMan initially scoring higher. A significant increase in the test scores was seen between the pre-test and the mid-test for this group (P=0.009). There was a similar albeit non significant trend between the midtest and the post-test for the group using peer examination initially.Mean confidence ratings increased from the pretest to midtest and then further in the post-test for both groups. Their confidence ratings increased significantly in differentiating between normal and abnormal signs [Group starting with SimMan, between pretest and midtest (P= 0.01) and group starting with peer examination, between midtest and post-test (P=0.02)]. When the students' ability to perform examination on each other for both groups was compared, there was a significant increase in the scores of the group starting with SimMan (P=0.007). Conclusions: This pilot study demonstrated a significant improvement in the students' knowledge and competence to perform chest examination after simulation with an increase in the student's perceived levels of confidence. Feedback from the students was extremely positive. SimMan acts as a useful adjunct to teach clinical skills to preclinical medical students by providing a simulated safe environment and thus aids in bridging the gap between the preclinical and clinical years in medical undergraduate education.
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