Medical Student Clerkship Research Articles

Perceived Impact of Resident Work Hour Limitations on Medical Student Clerkships: A Survey Study

To assess medical students' perceptions of the impact of recent Accreditation Council for Graduate Medical Education policies limiting resident work hours on students' clerkship experiences, resident teaching, and quality of patient care. In May/June 2003 and May/June 2004, an original questionnaire was administered to 252 medical students completing required clinical rotations at two teaching hospitals to assess students' perceptions of endpoints that might be affected by resident work hours limits. Response data were analyzed to determine statistical significance of differences between the two years studied. Questionnaires were completed by 129 students in 2003 (98%) and 112 students in 2004 (93%), for an overall response rate of 96%. A higher proportion of students perceived limits on work hours in 2004 [46 (41%)] than 2003 [36 (28%), p = .03]. Ratings of resident availability and primary resident's interest in teaching improved in 2004. Otherwise, ratings of the interest, skill, and availability of resident teachers and attending physicians remained stable between 2003 and 2004. Students reported spending similar amounts of time in formal teaching sessions and rated feedback similarly between 2003 and 2004. In 2004, fewer students [28 (25%)] reported considering leaving medicine due to long hours in training than in 2003 [49 (38%), p = .04]. No significant differences in the proportion of students reporting suboptimal care were found [44 (34%) in 2003, 34 (35%) in 2004, p = .57]. This small, early study suggests that reductions in resident work hours might be implemented without a significant negative impact upon medical students' self-assessed learning experiences, and that limiting resident work hours may even have a positive impact on medical students.

The Recruitment Phoenix: Strategies for Attracting Medical Students Into Obstetrics and Gynecology

In less than a decade, the popularity of obstetrics and gynecology as a career choice has declined significantly. The American College of Obstetricians and Gynecologists (ACOG) and the Association of Professors of Gynecology and Obstetrics (APGO) are working to develop a multifaceted approach aimed at reversing this trend. We report on the findings and action plan developed by the ACOG Medical Student Recruitment Task Force as well as the current activities of APGO related to recruitment. Strategies include improving the quality of the medical student clerkship, frankly addressing gender and lifestyle issues that dissuade students from choosing obstetrics and gynecology as a career, and engaging students early in their medical school careers through student interest groups and mentoring programs.

Case-Based Independent Study for Medical Students in Emergency Psychiatry

Brief cases designed for independent study were developed to allow third-year medical students some exposure to important concepts in emergency psychiatry during their required psychiatry clerkship. Five independent study cases were given to University of Michigan third-year medical students during their psychiatry clerkship, and their performance on a pre- and posttest of knowledge of emergency psychiatry management was compared between students who did and did not use the independent study cases. All of the students improved in their knowledge of emergency psychiatric management, but the students who completed the cases had a significantly better performance on the postrotation quiz. Case-based independent study is an effective method to improve exposure to emergency psychiatry cases during a third-year medical student clerkship.

Political and Budget Issues Associated with Educating Medical Students

Unfortunately for medical educators, medical student clerkships in emergency medicine (EM) do not occur in isolation from the key institutional issues of organizational politics and resource support. This article discusses some of the political and resource issues in proposing and obtaining support for a mandatory EM student clerkship. Political issues of importance include: 1) securing intradepartmental support from all faculty and the chair for the priority and teaching commitment of a mandatory clerkship; 2) strategizing the different steps and their sequencing for achieving clerkship approval, including cultivation of key supporters, content of a clerkship proposal, and resource support needs; 3) identifying and collecting data from existing EM teaching efforts that will support a mandatory clerkship proposal; 4) establishing a connection between the overall educational outcome objectives for students of the school and the educational outcomes for students taking the EM clerkship; and 5) developing solutions to logistic issues in clerkship implementation (availability of an adequate number of teaching sites; establishment of equivalence of educational experiences across all sites). A list of resources for a mandatory clerkship, an "ideal" budget, and potential rationales to advocate for resource support from specific funding sources are included.

Political and Budget Issues Associated with Educating Medical Students

Unfortunately for medical educators, medical student clerkships in emergency medicine (EM) do not occur in isolation from the key institutional issues of organizational politics and resource support. This article discusses some of the political and resource issues in proposing and obtaining support for a mandatory EM student clerkship. Political issues of importance include: 1) securing intradepartmental support from all faculty and the chair for the priority and teaching commitment of a mandatory clerkship; 2) strategizing the different steps and their sequencing for achieving clerkship approval, including cultivation of key supporters, content of a clerkship proposal, and resource support needs; 3) identifying and collecting data from existing EM teaching efforts that will support a mandatory clerkship proposal; 4) establishing a connection between the overall educational outcome objectives for students of the school and the educational outcomes for students taking the EM clerkship; and 5) developing solutions to logistic issues in clerkship implementation (availability of an adequate number of teaching sites; establishment of equivalence of educational experiences across all sites). A list of resources for a mandatory clerkship, an “ideal” budget, and potential rationales to advocate for resource support from specific funding sources are included.

Objective assessment of videoconferenced lectures in a surgical clerkship

Background A challenge to the practice of third-year clerkship rotations at remote locations is the maintenance of equivalent didactic lectures, especially in subspecialty components. There has been little objective assessment of the results of videoconference lectures on medical student clerkship education. Methods Third-year surgical clerkship students, randomly assigned to a 4-week rotation 75 miles from the medical school, received subspecialty lectures by interactive teleconference via an ISDN line at 128 kb/s. Weekly quiz results (% correct) of students who received videoconference lectures were compared with students receiving conventional lectures, and were analyzed by 2-tailed t tests for equality of means. Results A mean of 12 students were tested per quiz (range, 5–21 students) after videoconference lectures, and 98 students were tested after conventional lectures (range, 41–146 students). The mean quiz score of students receiving video lectures was 70.5% (range, 65.4% to 73.6%); and after conventional lectures the mean quiz score was 71.4% (range, 69.5% to 76.8%). There were no significant differences in the mean scores of the individual quizzes ( P = .16–.92) or between the totals ( P = .65). Conclusions Telemedicine, using interactive videoconferencing, is an effective method for didactic lectures in a surgical clerkship. This technology allows students to receive interactive lectures at distant clinical sites and limit their travel.

An educator's guide to teaching emergency medicine to medical students.

There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation.

Displaying faculty grade averages during 3rd year medical student clerkship evaluations: effects upon grade inflation

Background: Medical educators recognize grade inflation as a significant problem with multi-factorial etiologies beginning as early as junior medical student clerkship rotations. Colletti et al reported faculty educators’ inability or unwillingness to provide medical student trainees with unfavorable face-to-face evaluations as a source of grade inflation. The effects of un-countered grade inflation are significant, rendering academic deans and advisors less able to provide useful comparative evaluations and recommendations for matriculating students, and in one study (Speer et al), leaving nearly half of the faculty in an internal medicine clerkship concerned about “social-promotion” of failing students due to uncontrolled grade inflation. Little literature specifically addresses techniques to minimize grade inflation. Methods: Using our previously reported 360-degree web-based competency evaluation tool for 3rd year medical student clerkships, evaluation data were collected assessing nine evaluation items based upon the six ACGME “core competencies”. During part one of the study, evaluations were completed with faculty evaluators blinded to their averaged evaluation data. During part two of the study, real-time faculty mean and standard error evaluation data were prominently displayed on the evaluation instrument during faculty evaluations. We hypothesized that passive faculty notification of evaluation data would alter evaluations toward a more centrist mean, based upon changes in clinician ordering patterns observed when cost data were displayed. Results: Prior to and during Part One of the study, mean evaluation scores were significantly greater than the anticipated mean (2.5) for all items evaluated. 2043 individual evaluation scores were acquired, equally allocated between pre- and post-notification periods of the study. Mean evaluation scores were significantly greater than the anticipated mean (2.5) for all items evaluated. Data were evaluated using parametric (t-test) and nonparametric (Wilcoxon signed ranks test) statistical analyses comparing blinded and passive faculty notification evaluation data. Mean evaluation scores were noted to increase slightly for each of the nine evaluation items after commencement of passive notification, with one item achieving and three items approaching statistical significance. Conclusions: These findings appear to contradict our hypothesis that passive notification of faculty evaluation averages decrease evaluation means or improve grade inflation. Increasingly large datasets, obtained using on-line evaluation tools, will likely achieve statistical significance demonstrating that faculty should not be shown real-time grade averages during evaluation. We believe that these data support the need to develop alternate methods of managing grade inflation, including faculty education or parametric grade re-calculation as tools to counter grade inflation.

BUILDING A LEARNING EXPERIENCE: THE IMPLEMENTATION OF A CLERKSHIP IN GERIATRIC MEDICINE

Recent curriculum changes at McGill University include a mandatory 4-week clerkship for third-year medical students. The basis of this clerkship is the assessment and management of frail elderly who have a combination of complex acute and chronic medical problems and functional disabilities. It includes the understanding of the need for continuity of care across settings and the transition from hospital to the community. Our main purpose is to offer students a learning experience based upon self-reflection, access to technology, interactive learning and permanent feedback. To accomplish the technological goals, didactic sessions were mostly electronic-based with two main components: web-based interactive modules that include the contents in seven web-based interactive lectures complemented with pre- and post-tests, and an electronic portfolio to assess students' acquisition of skills and attitudes. We expect that implementation of this model of clinical clerkship will prepare future physicians, not only for the practice of geriatric medicine, but also for different medical and surgical specialties, and will enhance the attitudes, knowledge, and skills practitioners need to care for older people.

Improving the physical diagnosis skills of third-year medical students: a controlled trial of a literature-based curriculum.

To determine if a literature-based physical diagnosis curriculum could improve student knowledge, skill, and self-confidence in physical diagnosis. Prospective controlled trial of an educational intervention. Required internal medicine clerkship for third-year medical students at Brown Medical School. Third-year medical students who completed the internal medicine clerkship during the academic year 1999-2000: 32 students at 1 clerkship site received the intervention; a total of 50 students at 3 other clerkship sites served as controls. Physical diagnosis curriculum based on 8 articles from the Journal of the American Medical Association's Rational Clinical Examination series. Intervention students met weekly for 1 hour with a preceptor to review each article, discuss the sensitivity and specificity of the maneuvers and findings, and practice the techniques with an inpatient who agreed to be visited and examined. Physical diagnosis knowledge for the 8 topics was evaluated using a 22-item multiple choice question quiz, skill was evaluated using trained evaluators, and self-confidence was assessed using an end-of-clerkship survey. Intervention students scored significantly higher than the control group on the knowledge quiz (mean correct score 70% vs 63%, P =.002), skills assessment (mean correct score 90% vs 54%, P <.001), and self-confidence score (mean total score 40 vs 35, P =.003), and they expressed greater satisfaction with the physical diagnosis teaching they received in the clerkship. This physical diagnosis curriculum was successful in improving students' knowledge, skill, and self-confidence in physical diagnosis.

Medical student operative experience correlates with a match to a categorical surgical program

Background Interest in general surgical residencies has decreased significantly. Because medical student clerkship experiences may affect specialty preferences, we attempted to determine if the degree of exposure to surgical procedures influenced career choices. Methods Operations observed by students who completed the third-year surgical clerkship between 1998 and 1999 were reviewed. These 146 medical students, who matched to residency training programs in March 2000, were then divided into three groups based upon residency fields. Surgical case exposures were then compared between the groups. Results The total number of operations observed was similar between the groups. However, students who matched into categorical general surgical programs participated in significantly more abdominal and general surgical procedures than those matching in surgical subspecialty or nonsurgical residencies ( P < 0.01). Conclusions There appears to be a correlation between surgical case exposure during the third-year clerkships and future residency fields. Thus, the degree of exposure to surgical procedures may influence medical student career choices.

CANDIDATES FOR SPEAKER-ELECT

CANDIDATES FOR SPEAKER-ELECT

Distributed radiology clerkship for the core clinical year of medical school.

The central role that diagnostic radiology has in the modern practice of medicine has not always been reflected in radiology's place in the curriculum. We developed a new radiology clerkship for undergraduate medical students during their core clinical year that was supported by Web technology. The assumptions underlying the design of the clerkship were that radiology is best learned from radiologists and that students are most receptive to learning radiology when it is related to concurrent patient care experiences. Beginning in May 2000, a required radiology clerkship experience was incorporated into the core clinical year at Wake Forest University School of Medicine. The core clinical year was organized into three 16-week blocks of clerkships. Two or four independent half-day radiology tutorial sessions were included with each clerkship block, and attended by all students in the block (approximately 35 students), regardless of their specific clerkship assignments. There were ten different radiology tutorials, each given three times during the year as students rotated through the clerkship blocks. Thus, each student attended a radiology tutorial session every four to eight weeks during the year. The topics covered during the tutorials were correlated with the content of the clerkship blocks and included adult and pediatric chest radiology, adult and pediatric abdominal radiology, body CT, neuroradiology, obstetric ultrasound, gynecologic ultrasound, osteoporosis, adult and pediatric fractures, mammography, and cervical spine trauma. The tutorials included pre- and post-test, lectures, case presentations, and sometimes tours of the radiology department. The educational emphasis was on pragmatic case-based learning exercises, development of verbal and visual vocabulary, and learning when and where to seek more information. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the clerkship. The home page of the Web site provided the schedule, faculty names, attendance and grading policies, course overview, and links to individual tutorials. The pages for individual tutorials included educational objectives, glossary of radiology terminology relevant to the subject, lecture slides and handouts, and teaching cases. All students had laptop computers and access to the academic network, but did not use them during the actual tutorial sessions. Implementation of the radiology clerkship required extensive negotiation with directors of other clerkships so that students could be released from their other responsibilities in order to attend the radiology tutorials. The radiology clerkship format has proven to be complex in its administration, with faculty and students on different schedules commuting to the radiology lecture hall from various locations. Extensive use of e-mail and communication via the Web site have been instrumental in reminding faculty and students of upcoming sessions. Preliminary evaluations have indicated that students liked the radiology sessions and learned a great deal, but disliked the scheduling and the lack of continuity. An evaluation of the curriculum and its components is ongoing.

Implementing a mandatory geriatrics clerkship.

Due to the rapid growth in the proportion of U.S. citizens aged 65 and older (20% by 2030) it is imperative that U.S. medical schools train students who can provide quality care to the older population. Consequently, the objective of this paper is to report the experience of creating a 4-week, mandatory geriatrics clerkship for junior medical students. Funded by a grant from the Donald W. Reynolds Foundation, the University of Arkansas for Medical Sciences developed a mandatory, third-year clerkship in geriatric medicine. The clerkship included clinical experiences in outpatient clinics, transitional care units, nursing homes, hospice programs, and core didactic sessions. The sites for the clerkship were the University of Arkansas for Medical Sciences Hospital, the Central Arkansas Veterans Healthcare System Hospital, community nursing homes, and community hospice programs in Little Rock, Arkansas. The entire junior class of 135 students participated in the new clerkship. Students were assessed through a three-station Objective Structured Clinical Examination followed by a brief post- encounter examination and faculty preceptor evaluations collected from each clinical site. Students evaluated the clerkship through written evaluations and focus group discussions. This paper demonstrates that students acquired sufficient cognitive knowledge to satisfactorily complete the clerkship but did not highly value the experience.

Medical Students in Jail: The Psychiatric Clerkship in an Outpatient Correctional Setting

Some educators may view correctional settings as substandard sites for medical student clerkships in psychiatry. The authors report on 2 years of medical student evaluations of teaching and student performance outcomes from a psychiatric clerkship conducted in outpatient mental health clinics in a county jail system. When compared with other clerkship sites, the jail sites were rated equivalently for teaching and patient variety, and students at the jail sites performed comparably on exams and preceptor ratings.

Criteria of the "educators' pyramid" fulfilled by medical school faculty promoted on a teaching pathway.

To compare the results of academic promotion to associate professor and professor via the teaching pathway at the Wake Forest University School of Medicine (WFUSM) with the criteria of the "educators' pyramid" of Sachdeva et al. Data on all candidates promoted to associate professor and professor in the academic years 1995-2000 at WFUSM were collected from candidates' portfolios and compared with the criteria for educator (level three) and master educator (level four) from a modified version of the educators' pyramid. Of 186 faculty promoted, 38 were on the teaching pathway. Everyone promoted on the pathway fulfilled all teacher and master teacher criteria. All educator criteria were found among the associate professors, and all but one of the master educator criteria were found among professors. More than 75% of associate professors demonstrated "sustained participation in significant amounts of effective teaching in more than one modality" and "service as a medical student clerkship, course, or residency director." Less than 30% demonstrated "service as assistant dean of education or student affairs" or "service as the chair of departmental education committees." Most associate professors had not regularly participated in national education meetings. For professors, more than 50% demonstrated "achievement of leadership positions in national organizations, committees, and medical school education"; "recognition as a national leader in specialty education"; and "mentorship of other faculty members locally and nationally." Less than 30% demonstrated "pursuit of further training in education through workshops, faculty development programs, or educational fellowship programs" or "development and implementation of nationally-recognized (in education) innovative curricula or teaching programs." No one promoted to professor on the teaching pathway had made what was considered to be a landmark contribution to educational research and development. The findings suggest that the educators' pyramid is generalizable to medical faculty being promoted on a teaching pathway at WFUSM. Documentation of achievement in teaching criteria is essential and faculty should be encouraged to maintain records of accomplishment before becoming candidates for promotion.

Effect of obstetrics-gynecology clerkship duration on medical student examination performance

Objective: To compare medical student performance on the obstetrics and gynecology national board subject examination during two different clerkship rotation formats. Methods: We compared medical student performance on the National Board of Medical Examiners (NBME) subject examination in obstetrics and gynecology for 2 years before and 2 years after the length of the clerkship at the University of Florida was decreased from 8 to 6 weeks. Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) step 1 and step 2 scores were used to assess comparability between groups. Student t test and χ 2 analysis were used as appropriate. Results: Medical school classes were similar with respect to MCAT and USMLE step 1 and step 2 scores. Collectively, 231 students who completed the 8-week clerkship scored significantly higher on the subject examination than 239 who completed the 6-week clerkship (618.6 versus 593.5, P = .001). When analyzed by semester, students who completed the clerkship in the second half of the academic year scored similarly regardless of clerkship length (630.6 versus 616.7, P = .11); however, students who completed the clerkship during the first half of the academic year scored significantly higher with the 8-week than the 6-week clerkship (607.3 versus 569.7, P < .001). Students who took the clerkship in the last half of the academic year scored higher than students who took the clerkship in the first half for both the 8-week (630.6 versus 607.3; P = .02) and 6-week (616.7 versus 569.7; P < .001) formats. Those differences persisted on examination letter grade assignment. Conclusion: Decreasing the duration of the obstetrics-gynecology medical student clerkship resulted in lower subject examination scores, especially for students who matriculated in the first half of the academic year.

Psychiatry for Primary Care Physicians: A Reference for Physicians on Assessing and Treating Mental Health Disorders for Adults

Back to table of contents Previous article Next article Book Forum: ASSESSMENT AND DIAGNOSISFull AccessPsychiatry for Primary Care Physicians: A Reference for Physicians on Assessing and Treating Mental Health Disorders for AdultsWILLIAM M. GREENBERG, M.D., WILLIAM M. GREENBERGSearch for more papers by this author, M.D., Ramsey, N.J.Published Online:1 Oct 1999https://doi.org/10.1176/ajp.156.10.1657AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This volume, edited by two psychiatrists and an internist for use by the outpatient-based primary care physician, was developed by using a unique collaborative approach, teaming psychiatrists with primary care physicians for each chapter. The type size is somewhat small, but generous use of white space results in a very readable format, which complements the direct, jargon-free, clinically relevant writing style. A brief introduction is understated yet effectively motivational. One chapter introduces the process of psychiatric assessment (emphasizing biopsychosocial understanding and interview technique), another discusses psychiatric diagnosis according to DSM-IV, 11 chapters present psychiatric disorders by diagnostic category, one deals with violence and aggression, followed by chapters labeled “Difficult Patient Situations,” “Particular Mental Health Concerns of the Elderly, Gay Patients, and Women,” “Somatic Treatments,” and “Psychotherapeutic and Behavioral Treatments.” This structure is logical and avoids excessive repetition but separates details of treatment from discussion of the disorders.Psychiatrists might wish for a text such as this to help their primary care physician colleagues better understand the modern practice of psychiatry, but perhaps they also recall Alexander Pope’s admonition, “A little learning is a dangerous thing;/ Drink deep, or taste not the Pierian spring.” Might one modest-sized book lead a nonreferring primary care physician to get into trouble too often, or is perhaps Thom­as Huxley’s epithetic rejoinder more germane: “If a little knowledge is dangerous, where is the man who has so much as to be out of danger?” In this instance this potential risk does not seem paramount, particularly as the issue of when to refer is routinely addressed. Other strengths include the authors’ consistently emphasizing the problem of stigmatization, promoting the use of support groups and providing relevant telephone numbers, and offering brief relaxation technique instructions and the Mini-Mental State.As a first edition, this work constitutes an excellent effort of experienced academic clinician-authors. It is replete with much useful information and many clinical pearls but has such a broad scope that some room for improvement can be found. For example, in the chapter on depression I regretted not finding any mention of St. John’s wort, the possibility of antidepressant-induced mania or hypomania, or clear recognition of dysthymic disorder. The chapter on sexual disorders is solid, but there is no mention of sildenafil, which has so quickly changed patient workups and treatment. Oddly, there is not even a brief section anywhere dedicated to bipolar disorder, mania, or hypomania. I would have wished that a text for primary care physicians would at least mention the pregnancy risk for someone taking both carbamazepine and birth control pills, and of the teratogenic risks of lithium, carbamazepine, and valproate. My own pedagogic preference would also argue for including more case vignettes (some chapters do have effective examples).This book would probably work particularly well as part of a primary care residency training program or medical student clerkship, or as part of a liaison psychiatry course or teaching rounds, where clinical cases could make the material come more alive.By Larry S. Goldman, M.D., Thomas N. Wise, M.D., and David S. Brody, M.D. Chicago, American Medical Association, 1998, 389 pp., $49.95. FiguresReferencesCited byDetailsCited ByNone Volume 156Issue 10 October 1999Pages 1657-1657 Metrics History Published online 1 October 1999 Published in print 1 October 1999

Improving the Anesthesiology Clerkship for Medical Students

With the current emphasizing primary care specialty, the number of the applicants for anesthesiology residency has declined. In consequence, the medical students' interest in taking the elective anesthesia clerkship was decreased. Through the program redesign, we have improved our anesthesiology clerkship. In order to attract the best and brightest medical students to choose anesthesiology as a career, continuing efforts to improve both quantity and quality of medical students' education in anesthesiology are crucial.

Effect of residency program merger on undergraduate medical student education in obstetrics and gynecology

Objective: To evaluate the effect of residency program merger on third-year medical student clerkships using student evaluations of their experiences and standardized subject examination scores. Methods: End-of-clerkship ratings from student evaluations and National Board of Medical Examiners standardized subject examination scores in obstetrics and gynecology were used from clerkship sites where three separate military residency programs in obstetrics and gynecology recently merged into two new programs. Mean student evaluation scores and subject examination scores for the year preceding and the year following the merger were compared. Results: The mean differences in medical student evaluation scores before and after merger of the residency programs were 0.1 (Mann-Whitney rank sum, P = .1), −0.1 (Mann-Whitney rank sum, P = .8), and 0.2 (Mann-Whitney rank sum, P = .3). The mean differences for subject examination scores before and after merger of the residency programs were −3.5 (95% confidence interval [CI] −33.2, 26.2; paired t test), −30.1 (95% CI −58.9, −1.4; paired t test), and −35.3 (95% CI −74.8, 4.3; paired t test). Conclusion: Merger of residency programs in obstetrics and gynecology does not appear to have a deleterious effect on medical students’ satisfaction with the clerkship or their performance on standardized subject examinations at our institution.