Clerkship Programs Research Articles

Enhancing Inclusive Excellence in the Surgical Workforce: The Do's and Don'ts of Successful Visiting Student Clerkship Programs.

Enhancing Inclusive Excellence in the Surgical Workforce: The Do's and Don'ts of Successful Visiting Student Clerkship Programs.

Asserting Accountability to Address Diversity: Report Card as a System of Measurement.

To the best of our knowledge, there are no standard accountability measures for diversity efforts at the departmental level. Therefore, the purpose of this study is to evaluate a multiprong report card as a structure for evaluation, tracking, and reporting as well as to examine any relationships between expenditures and outcomes. We instituted an intervention that offered leadership a report card of metrics related to diversity efforts. Included are diversity expenditures, benchmark demographic and departmental data, applications to support faculty salaries, participation in clerkship programs focused on attracting diverse candidates, and requests for candidate lists. The purpose of this analysis is to demonstrate the impact of the intervention. A significant relationship was found between faculty funding applications and under-represented minority (URM) representation in a department (0.19; confidence interval [95% CI] 0.17-0.21; p<0.001). An association was also found between total expenditures and URM representation in a department (0.002; 95% CI 0.002-0.003; p<0.001). Other outcomes include the following: (1) women, URM, and minority faculty have all increased in representation since tracking began; (2) diversity expenditures and faculty opportunity fund and presidential professorship applications have increased over time; and (3) a steady decline in departments with zero URM representation after the tracking of diversity expenditures in both clinical and basic science departments. Our findings suggest that standardized metrics for inclusion and diversity initiatives promote accountability and buy-in from executive leadership. Departmental detail enables tracking of progress longitudinally. Future work will continue to evaluate the downstream effects of diversity expenditures.

Medical students' perceived stress and perceptions regarding clinical clerkship during the COVID-19 pandemic.

It is important to ensure that both the qualitative and quantitative aspects of clinical education are maintained during the pandemic. Understanding students' views on clinical rotations and the extent of their perceived pandemic-related stress would thus be useful for designing and implementing effective clerkship programs. Therefore, this study aimed to investigate perceived stress and perceptions regarding clinical clerkship among incoming clinical students (third year) and senior clinical students (fourth year) during the COVID-19 pandemic. After completing orientation programs at the beginning of the academic year, we surveyed students on their perceived stress, their general perspectives regarding the appropriate scope of clinical clerkship, and their preferences regarding level of participation in clerkship. We examined the differences in stress and clerkship-related perceptions based on the students' study year and sex using independent t-test, chi-squared test, and Fisher's exact test. In addition, the influences of stress, sex, and study year on clerkship-related perceptions were examined using multinomial logistic regression. The independent t-test indicated that third-year students experienced lower stress than did fourth-year students. Clerkship-related perceptions also differed significantly between third- and fourth-year students. Multinomial logistic regression analyses on the scope of and participation levels in clinical clerkship revealed that third-year students had significantly lower odds of preferring a limited range of clinical rotations and lower engagement in clerkships compared to fourth-year students. The COVID-19 pandemic has affected clinical education and, consequently, medical students' inclination toward active participation in clinical rotations. It is thus essential to understand students' views and provide them with relevant intra-pandemic educational supports.

A Blueprint for Increasing Ethnic and Racial Diversity in U.S. Residency Training Programs.

People who identify as African Americans, Latinos, or from indigenous backgrounds, are dramatically underrepresented in the U.S. physician workforce. It is critical for academic health centers to recognize racial and ethnic diversity at the residency level and implement changes to enhance diversity among trainees. The Office of Graduate Medical Education (GME) at the University of Pennsylvania Health System (UPHS) developed a multipronged approach to enhance diversity and inclusion (D&I) among residency trainees. The approach included the development of an underrepresented in medicine (UIM) professional network; UIM-focused visiting clerkship programs; holistic review implementation by selection committees; and targeted outreach to UIM candidates, overseen by an associate designated institutional official for UIM Affairs. The authors reported demographic data on residency applicants invited for interviews and matching for all programs at UPHS from 2014-2015 (baseline) to 2020-2021. They also reported data on maximum ranking number programs reached to fill their positions and the average United States Medical License Examination (USMLE) Step 1 scores of matched candidates. Finally, they discussed the implications for leaders who wish to enhance D&I at academic health centers. During the baseline year (2014-2015), UIMs represented 12.1% of interviewees and 8.7% of all matched candidates into UPHS residency programs. Over the successive 6 years after incremental implementation of the approach, UIM representation steadily increased. In 2020-2021, UIMs represented 23.2% of interviewees and 26.4% of matched candidates. Programs' maximum rank number to fill and USMLE Step 1 scores of matched candidates remained relatively unchanged. The UPHS Office of GME incorporated a purposeful approach to enhance the D&I of its residents. Across 6 years of implementation, UIM representation among resident matches tripled while quantitative program and candidate metrics remained unchanged. Similar efforts should be given further consideration for implementation and evaluation nationwide.

A return-on-investment analysis of impacts on James Cook University medical students and rural workforce resulting from participation in extended rural placements.

Although all medical students at James Cook University (JCU), Queensland, Australia, undertake rural placements throughout their course, a proportion (currently about 20 per year out of 170-190 final-year students) undertake extended rural placements in rural and remote towns - 5-month Integrated Rural Placement (IRP) or 10-month Longitudinal Integrated Clerkship (LIC) programs. This study uses a return-on-investment (ROI) approach to quantify student and rural medical workforce benefits arising from these 'extended placements' between 2012 and 2018. Seventy-two JCU MBBS graduates participated in extended rural placements between 2012 and 2018. In 2019, 46 of these graduates who had reached at least postgraduate year 2 and provided consent to be contacted for health workforce research were emailed a link to an online survey. Questions explored the key benefits to students' development of competencies and to rural medical workforce as a direct result of student participation in the IRP/LIC activities, as well as estimations of costs to students, deadweight (how much change would have occurred without participating in an extended placement), and attribution (how much change was due to other programs or experiences). The key student and rural medical workforce benefits were each assigned a 'financial proxy' to allow calculation of ROI from 2013 to 2019 as a dollar value, compared with the costs to students and to the JCU medical school from implementing the IRP/LIC programs between 2012 and 2018. Twenty-five of the 46 JCU medical graduates who undertook an extended placement responded (response rate 54%), reporting that the most common (96%) and most important benefit (56%) from their extended placement was 'greater depth and breadth of clinical skills'. Seventy-five percent (18/24; one missing response for this question) of the respondents also reported intending to have a full-time career in rural and remote practice. The overall cost of undertaking an IRP or LIC program for students between 2012 and 2018 was calculated to be $60,264, while the cost to the JCU medical school for sending 72 students out on extended rural placements was calculated as $32,560, giving total costs of $92,824. Given the total value of benefits ($705,827) calculated for the key student benefit of increased clinical skills and confidence in the internship year from participating in an extended placement ($32,197) and for the key rural medical workforce benefit of willingness to work in a rural or remote town ($673,630), the ROI from the extended rural programs between 2013 and 2019 (after students graduated and entered the workforce) is calculated at $7.60 for every dollar spent. This study confirms that undertaking an extended placement has significant positive impacts on final-year medical students' clinical confidence, clinical skills and communication skills into their internship year. In addition, the extended placements have longer-term impacts on the non-metropolitan health workforce by inspiring more JCU medical graduates to take up rural generalist, rural general practitioner or generalist specialist positions in rural and remote towns. This positive ROI from extended rural placements is important evidence for shifting the conversation around supporting these programs from one of cost to one of value.

Cardiothoracic Surgery Training Program Director Awareness of Available Visiting Medical Student Clerkships for the Underrepresented in Medicine

A diversity gap exists within cardiothoracic (CT) surgery that might be addressed with currently available medical student pipeline programs. We sought to assess CT surgery residency/fellowship program directors' (PD) awareness of and participation in underrepresented in medicine visiting medical student clerkship programs (UIM-VMSCPs). We reviewed the ACGME program finder database and medical school websites to identify thoracic surgery training programs that: (1) offer visiting student clerkships (VSCs), (2) are affiliated with an institution offering a UIM-VMSCP, (3) are at an institution where the existing UIM-VMSCP specifically offers rotations in CT surgery. The PDs in the second group were surveyed via e-mail, assessing their level of awareness of UIM-VMSCPs at their institution, participation in UIM-VMSCPs over the past 3 years, and desire to participate in a UIM-VMSCP in the future. All (n=76) ACGME CT surgery training programs were affiliated with institutions that offered VSCs in multiple disciplines. Over half, 55.3%, of the programs offered access to visiting students and 61.8% were at institutions with existing UIM-VMSCPs. Our response rate for the 47 PDs from institutions with UIM-VMSCPs was 38.2%. Of the respondents, 61.1% were aware of the UIM-VMSCP at their institution and 44.4% participated in the past 3 years. Most, 88.9% were interested in participating in their institution's UIM-VMSCP in the future. Only half of CT surgery training programs offer VSCs and even fewer are at institutions with an existing UIM-VMSCP that offers a CT surgery clerkship. This is a lost opportunity to broaden exposure to the specialty and increase diversity within the CT surgery workforce.

Virtual Ice Cream Rounds: Addressing medical clerk wellness during COVID-19.

Ice Cream Rounds (ICRs) are used by residency and clerkship programs across Canada to provide trainees with a safe space to debrief difficult situations, connect with peers, and promote wellness. At the Niagara Regional Campus of the Michael G. DeGroote School of Medicine, ICRs are held often and are well-received by learners. In light of the COVID-19 pandemic, we adapted and facilitated the first virtual ICR. Post-session, students reported an increase in nearly all domains of their perceived wellness. Due to the uncertainty associated with this unprecedented time, this event could help learners at other institutions support each other.

The do's, don'ts and don't knows of establishing asustainable longitudinal integrated clerkship.

IntroductionThe longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program.MethodAll four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do’s, Don’ts and Don’t Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline.ResultsThe final set of 18 Do’s, Don’ts and Don’t Knows is presented with an appraisal of the evidence for each one.ConclusionImplementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don’t Knows, in particular the question of how cost-effectiveness is best measured.

Outcomes and influences of rural-focused integrated clerkship programs in general surgery

BackgroundA shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. MethodsAn institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons. ResultsFifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision. ConclusionsA substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons.

The personalities of most medical students are suited to rural practice: Implications for rural education program recruitment

Introduction: The success of rural longitudinal integrated clerkship (LIC) programs has contributed to our understanding of selecting and training students for rural practice. Studies have explored the personality traits of students who participate in rural LICs although few have compared them with classmates who have not. The purpose is to compare personalities of four successive cohorts of students in the LIC Rural Physician Associate Program (RPAP) with their non-RPAP classmates.Methods: In a longitudinal cross-sectional design, medical students RPAP and non-RPAP, from 2013 to 2017 completed identical questionnaires comprising measures of personality, perfectionism, ambiguity tolerance, and resilience. T-tests, ANOVA, and post-hoc tests compared groups. K-means cluster analysis identified profiles of traits.Results: Total sample 286; RPAP = 128; non-RPAP = 158. Gender and age proportions were not different between groups. RPAP students were significantly lower in levels of perfectionism and higher in cooperativeness compared to non-RPAP classmates. Similar proportions of both groups were distributed across three personality profiles detected.Conclusions: Lower perfectionism implies advantages for rural practice. Nevertheless, similarities between groups suggest that most students would be successful in rural practice. More encouragement to all students may improve uptake of rural LICs. Greater attention to issues that affect decisions to explore rural medical education, particularly for our next generation of students, is required.

Learning in a High-Stress Clinical Environment: Stressors Associated with Medical Students’ Clerkship Training on Labor and Delivery

Phenomenon: Obstetrics and gynecology can be a high-stress clinical environment for medical students due to the specialty’s fast-paced and unpredictable nature. Little is known about learning stressors for medical students on the obstetrics and gynecology clerkship to inform stress-reducing interventions and improve learning experience. This study investigated (a) which aspects of the learning environment are most stressful for obstetrics and gynecology clerkship students, (b) how perceived learning stressors in this environment differ for medical students and teachers (residents, fellows, and faculty), and (c) what interventions students propose to address these stressors. Approach: From May 2015 to April 2016, we conducted semistructured individual interviews with 3rd-year medical students from obstetrics and gynecology clerkship cohorts (n = 52) as well as clerkship teachers (n = 10) at an academic medical center. Two investigators used a qualitative Framework Method approach to analyze the interview data and agree upon final themes. Findings: We identified labor and delivery as the most stressful learning environment and four labor and delivery–related themes of students’ learning stressors: context (pace, logistics, nature of childbirth, and nonroutine schedule), learning tasks (student role and assignments and the amount of new knowledge and skills), communication (terminology used in conversation and interacting with the labor and delivery team), and clinical scenario (crisis, emergency, and patient refusal of student involvement). Whereas students identified context as causing most of the stress, teachers concentrated on stressors related to learning tasks. Insights: Learning stressors associated with students’ educational experience in the clinical context of labor and delivery are challenging for medical students. In addition to the specific content of these challenges, the recognition that teachers’ assumptions about sources of stressors are different from those of students is an important finding and has implications for changing the learning environment. Clerkship programs are encouraged to provide practical guidelines and embed an introduction of the clinical learning environment into the Obstetrics and Gynecology clerkship orientation curriculum.

Medical Student Perceptions of On-Call Modalities: A Focus Group Study

Phenomenon: The call component of clerkship presents students with unique opportunities and challenges. Clerkship programs employ various call modalities, including traditional call, night float, and evening call. The impact of these call models on the student experience has not been explored in depth. Approach: Focus groups were conducted with 4th-year medical students, exploring their multidimensional experiences with various call modalities during clerkship. Transcripts were analyzed using thematic analysis. Findings: Thirty-nine students participated in 6 focus groups. Four overarching themes were identified: (a) educational value conferred by clinical exposure and teaching, (b) maintaining quality of life and developing features of burnout, (c) formation of professional identity via relationships with team members, and (d) perceived quality of patient care provided. Students associated evening call with burnout and poor educational value but also better patient continuity of care. Night float and traditional call contributed to a sense of team bonding and had enhanced perceived educational value while on call but resulted in loss of formal academic teaching time. Insights: Call modality impacts student learning, well-being, professional identity formation, and patient care; however, trade-off among these elements exists across all call models. Enhancing the value of student call experience may be achieved by implementation of various purposeful changes. These may include creating consistency between student and resident call schedules, maximizing recovery time between call shifts, and avoiding scheduling of students for call prior to academic sessions.

Evaluation of ophthalmology clerkships across teaching sites at the University of British Columbia

ObjectiveClerkship at the University of British Columbia (UBC) Medical School encompasses a variety of models: traditional rotation-based clerkship; distributed rotation-based clerkship at sites across the province; and a longitudinal integrated community clerkship. The purpose of this study was to: (i) Evaluate the undergraduate ophthalmology clerkship experience at UBC to compare outcomes and experiences across the various sites and models; and (ii) Apply educational theories to evaluation outcomes in order to improve curriculum design for clerkship programs. DesignCross-sectional evaluation of the ophthalmology clerkship program at UBC. MethodsUsing a logic model, we identified inputs, activities, and outputs of the ophthalmology clerkship experience at each site at UBC. Site directors and administrators were contacted for information regarding program curriculum and delivery, and outcomes were described using written exam and clinical assessment scores as well as student and instructor feedback (questionnaires with narrative responses). ResultsSite directors and administrators from all clerkship sites participated in the study. Clerkship experiences across all sites (rotation-based and integrated community clerkship) were found to be unique in contexts and clinical activities. There were no significant differences noted between outcomes in the rotation-based sites. ConclusionClerkship experiences can be delivered in various contexts and through varied clinical settings, yet provide an equivalent student learning experience. As longitudinal and distributed clerkship models gain traction in medical education around the world, there are lessons for undergraduate medical education both in ophthalmology and in other areas.

Association between rural clinical clerkship and medical students' intentions to choose rural medical work after graduation: A cross-sectional study in western China.

BackgroundA large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China.MethodsBased on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses.ResultsApproximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background.ConclusionsRural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure.

The Concept and Background for Introducing Longitudinal Integrated Clerkships

A traditional clerkship consists of a series of short rotations in specialty disciplines and is usually based in tertiary, urban teaching hospitals. Shortened inpatient stays and the shift toward ambulatory management have had a negative impact on student learning. There have been growing concerns that the traditional specialty-based clerkship in fragmented and highly specialized clinical environments may not be the optimal choice for basic clinical education. As a result, a new model of clinical clerkship called longitudinal integrated clerkships (LICs) has emerged. There is increased interest in LICs due to the growing evidence of positive outcomes for students, patients, and supervising clinicians. Emphasizing continuity as one of the main organizing principles of an LIC, this article reviews the introduction of LICs into medical education, the key concepts and educational theories which underpin LICs, and the typology of LICs. The author also offers some personal suggestions for contemplation before clerkship programs in Korea adopt LICs.

Community-based medical education in action: primary care physicians’ perceptions

Introduction and objectives: During the last decade, in response to wide ranging changes in healthcare systems and physicians' roles, the medical curriculum has undergone some modification. To achieve high quality education, 2 strategies are suggested: (1) Community-based medical education and (2) Community-oriented medical education. During the process of curriculum planning, the planners need to identify the potential areas for improvement and to guarantee the quality of instruction. This study aimed to determine the viewpoints of medical graduates from Qazvin University of Medical Science (QUMS), Tehran, on community medicine internship and clerkship programs (CMICP) in order to assist better decision-making by policymakers.Methods: In this qualitative study, the conventional content analysis approach was employed. Data were gathered from 20 primary practitioners of QUMS through individual semi-structured interviews and focus group discussions (FGD) which were continued until data saturation occured. The interviews were transcribed and analyzed immediately after the interviews. To analyze the data, one note was employed and to analyze the qualitative data, inductive method was used. The unit of analysis was selected and labeled using an open coding system. Then, the similar open codes were categorized in subthemes and finally the subthemes were organized into the main themes. Findings: The results of data analysis identified 4 main themes including: planned curriculum, delivered curriculum, hidden curriculum and curriculum evaluation.Conclusion: Many graduates suggest that, in addition to curriculum renewal, curriculum planners should identify mediated factors in CMICP to prepare graduates to practise in healthcare settings.

A Foundation for Vital Academic and Social Support in Clerkships: Learning Through Peer Continuity

Most medical students on clerkships currently experience lack of continuity of patient care, disjointed learning, and frequent changes in supervisors. Clerkship programs with continuity of care, curriculum, and supervisors appear to benefit student learning and patient-centeredness. A fourth form of continuity is proposed: continuity of peers, in which a stable cohort of students frequently meets to process their experiences on clerkships. This structure builds on benefits previously seen in peer-assisted learning, including enhanced knowledge, technical skills, and collegial peer relationships. Additional advantages of peer continuity in clerkships include facilitated integration into the workplace, social support, and enhanced clinical and professional learning. Practical components required for a successful peer continuity structure include intentional formation of peer cohorts; regular meetings that cover didactic or clinical skills learning; frequent opportunities for reflection on patient care, professional development, and well-being; and skilled facilitators without evaluative roles. Theoretical support for peer continuity comes from social cognitive theory, communities of clinical practice, and social comparison theory. Therefore, in conjunction with empirical programs that have shown benefits of developing these structures, peer continuity should become a formalized educational structure in clerkships.

Perceived Stress on Labor and Delivery (L&amp;D) During OB/GYN Clerkship From Students, Residents, and Faculty's Perspectives

BACKGROUND: Appropriate stress levels can stimulate medical trainees to think and react quickly. However, little is known about the effects of stress on medical students' learning on L&amp;D which is characterized by a complex, dynamic and unpredictable teamwork environment. Likewise the specific factors contributing to students' stress on L&amp;D have not been reported. METHODS: Individual interviews were conducted with 3 consecutive cohorts of students at the end of their OB/GYN clerkships and a group of OB/GYN residents and faculty through convenience sampling in 2015. Participants were asked to identify the most stressful clinical setting during the clerkship and factors contributing to the stress in this environment. Thematic analysis and manual coding were applied to code and synthesize the data to identify the perceived stressful factors among students, residents, and faculty. RESULTS: L&amp;D was the most stressful learning environment during the OB/GYN clerkship as reported by 14/19 students (73.7%). A total of 11 stressful factors from 4 categories were identified: 2 (terminology, interacting with residents) classified as Interpersonal Communication; 4 (pace, logistics, intrinsic sensitive nature of L&amp;D, non-routine schedule) considered as Context; 3 (crisis, emergency, patient refusal of student involvement) fell into Clinical Scenario; 2 (student role and assignment, the amount of new knowledge and skills required) identified as Learning Tasks. Most residents and faculty (75%) reported that factors from Context would contribute to students' stress on L&amp;D, and all students (100%) agreed. The majority of residents and faculty believed factors from Learning Tasks were stressful for students; but only 26.3% of students shared the same perception. DISCUSSION: Context factors contributing to stress were perceived by students, residents and faculty alike as contributing to stress and considered non-controllable, whereas OB/GYN residents and faculty differed in the perception of the effects of Learning Tasks on stress from students' perception. Clerkship programs are encouraged to integrate preparation of Context into curriculum through educational interventions to optimize students' stress level without increasing residents' and faculty's teaching pressure.

Using area health education centers to promote interest in rural practice

In the USA, area health education centers (AHECs) work to recruit and educate students to serve in medically underserved communities, primary care, and rural settings. One important aspect of their work is connecting students with rural clinical experiences. Within these experiences, AHECs incorporate a community health/socioeconomic experience within the family medicine clerkship that may not be as prevalent in the standard family medicine clerkship experiences. The purpose of the study was to assess the relationship between AHEC-sponsored family medicine clerkships with a self-reported intent to practice in a rural setting upon graduation. The study compared third-year medical students with the Indiana University School of Medicine, which participated in AHEC-sponsored family medicine clerkships to the standard family medicine clerkship. Following the 4-week clerkship, students were asked to report their intent to work in a rural setting using a five-point Likert scale. A &#967;2 test was used to determine the association of AHEC sponsorship, clerkship site location (rural/urban) and intent to practice in a rural setting. The study consisted of 587 students. There was a statistically significant association between self-reported intent and rural clerkship site, &#967;2 (1, <i>N</i>=587)=6.542, <i>p</i>=0.01. Furthermore, 21.6% (<i>n</i>=25) of students with a rural clerkship experience reported a greater intent compared to 12.3% (<i>n</i>=58) of students with non-rural clerkship experience. The study confirmed a significantly positive association between participation in medical clerkship experiences in a rural primary care setting and the intent to practice in a rural setting upon graduation. The results also support the potential value-added benefits through academic-community partnerships with AHECs, family medical and other primary care specialty clerkship programs may perhaps succeed in increasing student interest in pursuing a practice serving in rural communities upon graduation.

Can enriching emotional intelligence improve medical students' proactivity and adaptability during OB/GYN clerkships?

ObjectivesThe purpose of this pilot study was to examine our hypothesis that enriching workplace emotional intelligence through resident coaches could improve third-year medical students’ adaptability and proactivity on the Obstetrics and Gynecology clerkship.MethodsAn observational pilot study was conducted in a teaching hospital. Fourteen 3rd year medical students from two cohorts of clerkships were randomly divided into two groups, and equally assigned to trained resident coaches and untrained resident coaches. Data was collected through onsite naturalistic observation of students’ adaptability and proactivity in clinical settings using a checklist with a 4-point Likert scale (1=poor to 4=excellent). Wilcoxon rank-sum test was used to compare the differences between these two groups.ResultsA total of 280 data points were collected through onsite observations conducted by investigators. All (n=14) students’ adaptability and proactivity performance significantly improved from an average of 3.04 to 3.45 (p=0.014) over 6-week clerkship. Overall, students with trained resident coaches adapted significantly faster and were more proactive in the obstetrics and gynecology clinical setting than the students with untrained coaches (3.31 vs. 3.24, p=0.019). Conclusions Findings from our pilot study supported our hypothesis that enriching workplace emotional intelligence knowledge through resident coaches was able to help medical students adapt into obstetrics and gynecology clinical settings faster and become more proactive in learning. Clerkship programs can incorporate the concept of a resident coach in their curriculum to help bridge medical students into clinical settings and to help them engage in self-directed learning throughout the rotation.