Overspecialized and undertrained? Patient diversity encountered by medical students during their internal medicine clerkship at a university hospital.

Jan-Philipp Gutowski,Sigrid Harendza,Simon Melderis

doi:10.1186/s12909-015-0353-y

Jan-Philipp Gutowski, Sigrid Harendza + Show 1 more

Open Access

https://doi.org/10.1186/s12909-015-0353-y

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Abstract

BackgroundDuring the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care. Little is known about what constitutes their typical learning experiences with respect to patient diversity within the different subspecialties of internal medicine and during on call hours.Methods25 final year medical students (16 female, 9 male) on their internal medicine clerkship participated in this observational single-center study. To detail the patient diversity encountered by medical students at a university hospital during their 16-week internal medicine clerkship, all participants self-reported their patient contacts in the different subspecialties and during on call hours on patient encounter cards. Patients’ chief complaint, suspected main diagnosis, planned diagnostic investigations, and therapy in seven different internal medicine subspecialties and the on call medicine service were documented.Results496 PECs were analysed in total. The greatest diversity of chief complaints (CC) and suspected main diagnoses (SMD) was observed in patients encountered on call, with the combined frequencies of the three most common CCs or SMDs accounting for only 23% and 25%, respectively. Combined, the three most commonly encountered CC/SMD accounted for high percentages (82%/63%), i.e. less diversity, in oncology and low percentages (37%/32%), i.e. high diversity, in nephrology. The percentage of all diagnostic investigations and therapies that were classified as “basic” differed between the subspecialties from 82%/94% (on call) to 37%/50% (pulmonology/oncology). The only subspecialty with no significant difference compared with on call was nephrology for diagnostic investigations. With respect to therapy, nephrology and infectious diseases showed no significant differences compared with on call.ConclusionsInternal medicine clerkships at a university hospital provide students with a very limited patient diversity in most internal medicine subspecialties. Shadowing the on call resident or shorter rotations could provide a more extended patient diversity.

Highlights

During the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care
We looked for common general internal medicine diseases, in particular for: atrial fibrillation, anaemia, respiratory tract infections, COPD, diabetes, hypertension, Table 2 Percentage of subspecialty-specific main diagnoses per subspecialty
Acquisition of general internal medicine knowledge and basic diagnostic, therapeutic and management skills are an important goal of internal medicine clerkships during undergraduate medical education

Summary

Introduction

During the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care. General internal medical diseases such as hypertension, diabetes or renal insufficiency are highly prevalent in adults [1] and will be even more relevant in the future due to an aging population in many countries [2,3]. They can interfere with the management of other, unrelated problems, e.g. perioperative care [4,5] or anaesthesia [6] and require an acquaintance with multiple medications from all medical disciplines [7]. If learning objectives for general internal medicine are not well defined, these circumstances could lead to a lack of general internal medicine training

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