Despite the move toward integrated 4-year medical
school curricula, many medical schools still offer a tra-
ditional “2+2” curriculum divided into preclinical and
clinical phases. These two phases have distinct learn-
ing environments and require different learning skills.
Preclinical students operate in largely objectivistic
learning environments with structured goals and less-
flexible content. Clinical medical students function in
clerkships and post-clerkship experiences with different
learning models that provide real-life clinical activities,
offer guidance at critical times, and require knowledge
assembly rather than knowledge from memory.
To succeed in their clerkships, clinical students
must develop new skills, such as clinical reasoning
and multidisciplinary teamwork, in environments that
are often primarily designed for patient care and that
may interfere with learning.1 Many medical students
feel unprepared to begin their clerkships1 and find the
conversion to clinical learning particularly stressful.2
Clerkship directors across specialties also report that
students are inadequately prepared to start their clerk-
To bridge the gap between the preclinical and clini-
cal years, and to help students prepare for the different
learning environment, many medical schools offer
transitional courses before the third-year clerkships.4,5
These transitional courses vary widely across institu-
tions in structure and content,4,5 in part because there
has been no consensus document defining the knowl-
edge and skills that medical students need to become
learners in clinical settings. The medical content of
clinical clerkships, including procedural skills, has been
described,6,7 but there is little literature identifying other
skills, critical to the learning process, such as finding
and assessing clinical information and interpreting
Recently, as part of the Family Medicine Curricu-
lum Resource Project, an interdisciplinary committee
completed the Competency-based Curriculum Re-
source for Pre-Clerkship Education,8 a document that
outlines suggested goals and objectives for each of the
Accreditation Council for Graduate Medical Education
(ACGME) six competency areas that students should
master prior to the clinical years. The content in this
A Short Transitional Course Can Help Medical
Students Prepare for Clinical Learning
Heidi Chumley, MD; Cynthia Olney, PhD; Richard Usatine, MD; Alison Dobbie, MD
From the Department of Family Medicine, Kansas University Medical
Center (Drs Chumley and Dobbie); and the Department of Family Medicine,
University of Texas Health Science Center at San Antonio (Drs Olney and
Background and Objectives: Despite the move toward integrated 4-year medical school curricula,
many medical schools still offer a “2+2” curriculum divided into preclinical and clinical phases.
These phases represent distinct learning environments that require different learning skills. To pre-
pare students for learning in the clinical environment of the second 2 years, many medical schools
offer transitional experiences before the third-year clerkships. Few of these transitional courses
have published evaluations, and there is no consensus on the ideal content. In this paper, we provide
evaluation and content validity data on a 2-week intensive clinical transition course for beginning
third-year medical students. Methods: A multidisciplinary team designed, implemented, and evaluated
a 2-week transition course. Students indicated through surveys how prepared they felt for 18 clinical
skills. We analyzed pre- and post-survey data using a Wilcoxen rank sum test and compared current
to prior students using a chi-square analysis. Results: Students felt more prepared for 16 of 18 skills
after the transitional course and for 14 of 18 skills compared to historical controls. Conclusions: A
transitional course based on common skills is relevant to students’ clerkship experiences and can
increase students’ self-reported preparedness for the clinical years of medical school.
(Fam Med 2005;37(7):496-501.)
Medical Student Education
Vol. 37, No. 7
Medical Student Education
All successful medical students must adapt to the
different learning models common to clinical learn-
ing. Clinical Foundation courses have the potential to
help students feel better prepared for the transition to
the clinical years by giving them exposure to the skills
they will need to succeed. We did, however, find that
students felt inadequately prepared to protect patient
privacy before patient contact. Assessment of transi-
tion courses can be replicated in other institutions
and help those medical schools determine if they are
satisfied with the skill levels obtained by their students
in various stages of clinical training. Curricula at the
preclinical, Clinical Foundation, and clerkship stages
can be informed by such data.
Acknowledgment: This study was presented at the Society of Teachers of
Family Medicine 2005 Predoctoral Education Conference in Albuquer-
Corresponding Author: Address correspondence to Dr Chumley, Kansas
University Medical Center, Department of Family Medicine, 3901 Rain-
bow Blvd, Kansas City, KS 66160. 913-588-1948. Fax: 913-588 2496.
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