Clinical Clerkship Experience Research Articles

Becoming a doctor: using social constructivism and situated learning to understand the clinical clerkship experiences of undergraduate medical students

BackgroundDespite the emphasis on the uniqueness and educational importance of clinical clerkships in medical education, there is a lack of deep understanding of their educational process and outcomes. Especially due to an inherent trait of clinical clerkships which requires participation in the workplace outside the classroom, it is difficult to fully comprehend their educational potential using traditional learning perspectives such as imbibing outside knowledge. Accordingly, this study aims to explore the experiences of a rotation-based clerkship of medical school students from the perspective of social constructivism of learning, which can empirically examine what and how medical students learn during clinical clerkship in South Korea. By providing an insight into the workings of the clerkship process, this study contributes to a better understanding of how a learning-friendly environment can be cultivated at clinical clerkships.MethodsThe study utilized a basic qualitative study to understand what and how medical students learn during their clinical clerkships. Semi-structured, in-depth individual interviews were conducted with eight sixth-graders who had experienced a two-year clerkship at Ajou University Medical School. Data were analyzed based on Lave and Wenger’s situated learning theory and Wenger’s social theory in learning.ResultsWe found that the medical students had developed different aspects of their professional identities such as values, functionality, career decisions, sociality, and situating during their clinical clerkships. Further, professional identity was formed through a combination of participation and reification—the processes involved in the negotiation of meaning. This combination was facilitated by the students’ first experience and relationships with professors, classmates, and patients. Finally, non-learning occurred in the context of over-participation (learning anxiety and alienation) or over-reification (evaluation and e-portfolio).ConclusionsThis study revealed five sub-professional identities and their formation process from the learners’ perspective, thereby uncovering the unique learning characteristics and advantages of rotated-based clerkship and contributing to a further understanding of how gradual improvements can be made to the traditional clerkship education of medical students.

How medical students' trauma histories affect their clinical clerkship experiences.

As the gender demographics of medical students have evolved over the past decades, it is important to understand potential stressors and challenges that may affect clinical learning experiences. This study investigated the prevalence of prior sexual assault (SA) and interpersonal violence (IPV) in medical students and how these affect their clinical clerkship experiences. A survey was distributed to third- and fourth-year medical students at a single institution in August 2022 querying respondents on demographics and prior experiences with SA/IPV at any point in their lives. Respondents who indicated they had previously experienced SA/IPV were directed to questions about how these experiences affected clerkships. Of 419 students, 125 responded to the survey (30.8% response rate). Forty (31.1%) reported a history of SA/IPV-32 (80.0%) women, five (12.5%) men, and three (7.5%) who did not report gender or identified as non-binary. Of the 40 respondents with a history of SA/IPV, 20 (50.0%) reported that their prior history affected their overall clinical experience, and nine (22.5%) felt that it affected their performance. Only seven (17.5%) reported using any resources, such as counselling, during their clerkships. Narrative responses discussed significant effects on performing physical exams, taking a history, interacting with team members, and engaging during clerkships. This work demonstrates the high number of students affected by SA/IPV and how these prior experiences affected core components of their clerkship experiences. Institutions must be proactive to create better supports for learners with histories of trauma, including SA/IPV.

Using Video to Improve Understanding of Anatomy for Clinical Medical Students

Study Objective Surgical videos allow students to observe cases prior to entering the operating room, thereby improving the intra-operative learning experience for both the student and the educator. Minimally invasive surgery is especially suited to this modality of teaching. We created an interactive video series that allows students to better understand the elements of common gynecologic procedures, including laparoscopic salpingectomy-oophorectomy. Design This video on laparoscopic salpingectomy-oophorectomy was created as part of a 4-part series demonstrating common gynecologic procedures. The video reviews the indications for the procedure, basic tools used, port-site placement, and surgical footage of the laparoscopic entry, surveillance, peritoneal lavage, and removal of the ovary and fallopian tube to help students become more familiar with the different elements of the case. Setting The video was produced by the UCSF Educational Department to be used by third-year medical students during their OB-GYN rotation at an academic teaching hospital. Patients or Participants Videos were created for clinical medical students and narrated by senior medical students. Interventions The videos were shared on the OB-GYN rotation website. Following completion of the video, students were asked to complete a short anonymous survey about the effectiveness of the videos. Measurements and Main Results Of the 29 students who participated in the survey, 27 (93.1%) felt that they were significantly or somewhat more prepared to participate in the operating room after watching these videos compared to prior. Students found that the videos were either extremely or very useful for learning gynecologic anatomy (n=23, 79.3%) or learning the steps of surgical procedures (n=24, 82.8%), and 23 students (79.3%) were extremely or very willing to recommend these videos to their classmates. Conclusion Surgical film for medical students can improve the understanding and comfort in the operating during clinical rotations and enhance the clinical clerkship experience.

Changing attitudes to psychiatry and interest in the specialty as a career choice during clinical undergraduate years at a medical school in Penang, Malaysia.

Studies have suggested that the undergraduate clinical clerkship improves medical students' attitudes to psychiatry and career interest in the specialty, but few studies have explored the sustainability of these changes. To explore changes in students' attitudes to psychiatry and career preference for psychiatry during the course of their senior clinical years at RCSI & UCD Malaysia Campus (RUMC). All year 3 students (n = 111) at RUMC were invited to complete the Attitudes towards Psychiatry questionnaire (ATP-30) and a separate questionnaire seeking opinions on career preferences. The questionnaires were administered at 3 points in time: in year 3 before the 8-week psychiatry posting, following completion of the posting in year 4, and at the end of year 5. Quantitative data analysis was performed using SPSS version 18, and free-text responses were thematically analysed. One hundred completed questionnaires (90.1%) were returned. There was a significant improvement in students' ATP scores after their psychiatry rotation and this was sustained into year 5. Psychiatry as a career choice had highest preference levels following completion of the clerkship but declined in year 5 to below pre-clerkship preference levels. Qualitative analysis of factors influencing a career in psychiatry revealed themes of job satisfaction, lifestyle factors, perceived image of psychiatry, and self-appraisal. Our findings suggest that an enriched undergraduate clinical clerkship experience can help to sustain improved attitudes to psychiatry into the final medical year. However, declining interest in the specialty a career choice prior to graduation presents an enduring challenge.

Medical students' satisfaction with clinical clerkship and its relationship with professional self-concept.

PurposeMedical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students’ satisfaction with clinical clerkship and professional self-concept.MethodsThis investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables.ResultsWe found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students’ clinical clerkship experience and professional self-concept formation.ConclusionOur study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students’ professional self-concept formation.

Exploring variability of teaching & supervision at clinical clerkship teaching sites.

Objective:To explore undergraduate medical students’ perception of variation in teaching and supervision at different clinical teaching sites.Methods:This descriptive cross-sectional study was conducted at the College of Medicine & Health Sciences, United Arab Emirates University, UAE during 2017. Four clinical teaching sites affiliated with CMHS were evaluated namely Shaikh Khalifa Medical City (SKMC), Ambulatory Care Clinics (AC), Tawam Hospital (TH) and Al-Ain Hospital (AH). An online questionnaire was administered to year five and six students.Results:The response rate was 84.4%. Overall perception of the students about their clinical clerkship experience was positive. SKMC was rated as the best teaching site with mean rating of 3.79±0.97-4.79±0.43. The highest rated item was clinical teacher’s promotion of critical thinking in students while the lowest rated item was the opportunity to take responsibility for patient care. Ambulatory Care site had a mean rating of 2.33±1.23-4.13±1.19. The highest rated item at this site was the clinical teacher encouraging students to ask questions and participate actively. At Tawam Hospital, the mean ratings ranged between 2.65±1.64-4.31±0.86 with highest rated item being ability of the students to see cases with positive clinical findings. At the Al-Ain Hospital, the mean rating was in the range of 2.79±1.45-3.81±1.11. The item rated highest here was the ability of students to see cases with positive clinical findings. The lowest rated item at all three sites was the availability of on-call rooms and lockers. Significant variability was seen across training sites in the clinical teacher’s ability to act as professional role models, the opportunity for students to apply their previous knowledge to patient care and to independently assess patients before discussion with teachers.Conclusion:This study tool highlights variation in clinical teaching and supervision at four clinical teaching sites. It provides specific, actionable information which can be utilized to deliver equitable learning experiences across clinical clerkships and teaching sites. It places emphasis on the fact that lack of physical facilities hampers clinical teaching and supervision, hence, on call rooms, lockers and separate rooms for independent student interaction with patients should be provided at all clinical teaching sites.

Administering a Rural Longitudinal Integrated Clerkship Across 5 US States

This article illustrates the administrative structure that has evolved to support a multistate longitudinal inte- grated clinical clerkship (LICC) experience. In 1996 the University of Washington School of Medicine created the WWAMI Rural Integrated Training Experience (WRITE), a five-month rural continuity based LICC experience. WRITE students spend five months in a rural immersion experience with a primary care preceptor. During this time students form continuity based relationships with patients and preceptors, which allows students to develop skills and knowledge re- quired to treat the broad range of medical, surgical, and psychosocial problems found in rural communities. Administration of 21 rural sites across five states is based on a strong partnership between rural practice sites, regional clinical deans'offices, and the departments and dean's office in an academic medical center.We explore the key aspects of the multi-layered administration that has evolved to support the WRITE program. A review of the year-long calendar of the WRITE program illustrates the complexity, detail and components necessary for the administration of this successful program.Rural LICC experiences like WRITE offer a useful approach to meeting rural physician workforce needs. A brief review of the WRITE outcome data will be explored. Administration of a multistate LICC experience requires synchroni- zation of many components, especially a strong regional administrative presence that connects the rural practice sites with the academic medical center.

Clinical clerkship timing revisited: Support for non-uniform sequencing

Background: The logistical necessity of students taking required clinical clerkship rotations in non-uniform sequences may have significant consequences on performance.Aims: To investigate (1) the impact of previous clinical clerkship experience and the national licensing examination (USMLE Step 1) rankings on end-of-clerkship overall skills assessments and (2) the effect of clinical clerkship order on end-of-year objective structured clinical examination (OSCE) performance.Method: The core clinical phase of UCLA consists at six clinical clerkships during a 48-week continuum. The clerkships are structured in two different tracks with different rotation order. Clinical performance scores were analyzed for 124 year-3 students in the two different tracks.Results: Performance, as reviewed on a standardized clinical clerkship evaluation form by faculty and residents, improved significantly across the clinical year, regardless of track suggesting an accumulated advantage of previous experiences. There were no significant differences between tracks on the OSCE.Conclusions: Overall clinical skills are more directly impacted by the time-of-year and not order whereas knowledge of specific specialties may be impacted by the order rotations that are taken. While this may not be obvious to students, perhaps we should share these results for their use in tracking their personal growth in clinical skills.

Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

BackgroundMedical knowledge encompasses both conceptual (facts or “what” information) and procedural knowledge (“how” and “why” information). Conceptual knowledge is known to be an essential prerequisite for clinical problem solving. Primarily, medical students learn from textbooks and often struggle with the process of applying their conceptual knowledge to clinical problems. Recent studies address the question of how to foster the acquisition of procedural knowledge and its application in medical education. However, little is known about the factors which predict performance in procedural knowledge tasks. Which additional factors of the learner predict performance in procedural knowledge?MethodsDomain specific conceptual knowledge (facts) in clinical nephrology was provided to 80 medical students (3rd to 5th year) using electronic flashcards in a laboratory setting. Learner characteristics were obtained by questionnaires. Procedural knowledge in clinical nephrology was assessed by key feature problems (KFP) and problem solving tasks (PST) reflecting strategic and conditional knowledge, respectively.ResultsResults in procedural knowledge tests (KFP and PST) correlated significantly with each other. In univariate analysis, performance in procedural knowledge (sum of KFP+PST) was significantly correlated with the results in (1) the conceptual knowledge test (CKT), (2) the intended future career as hospital based doctor, (3) the duration of clinical clerkships, and (4) the results in the written German National Medical Examination Part I on preclinical subjects (NME-I). After multiple regression analysis only clinical clerkship experience and NME-I performance remained independent influencing factors.ConclusionsPerformance in procedural knowledge tests seems independent from the degree of domain specific conceptual knowledge above a certain level. Procedural knowledge may be fostered by clinical experience. More attention should be paid to the interplay of individual clinical clerkship experiences and structured teaching of procedural knowledge and its assessment in medical education curricula.

Early Bedside Care During Preclinical Medical Education: Can Technology-Enhanced Patient Simulation Advance the Flexnerian Ideal?

Flexner wanted medical students to study at the patient bedside-a remarkable innovation in his time-so that they could apply science to clinical care under the watchful eye of senior physicians. Ever since his report, medical schools have reserved the latter years of their curricula for such an "advanced" apprenticeship, providing clinical clerkship experiences only after an initial period of instruction in basic medical sciences. Although Flexner codified the segregation of preclinical and clinical instruction, he was committed to ensuring that both domains were integrated into a modern medical education. The aspiration to fully integrate preclinical and clinical instruction continues to drive medical education reform even to this day. In this article, the authors revisit the original justification for sequential preclinical-clinical instruction and argue that modern, technology-enhanced patient simulation platforms are uniquely powerful for fostering simultaneous integration of preclinical-clinical content in a way that Flexner would have applauded. To date, medical educators tend to focus on using technology-enhanced medical simulation in clinical and postgraduate medical education; few have devoted significant attention to using immersive clinical simulation among preclinical students. The authors present an argument for the use of dynamic robot-mannequins in teaching basic medical science, and describe their experience with simulator-based preclinical instruction at Harvard Medical School. They discuss common misconceptions and barriers to the approach, describe their curricular responses to the technique, and articulate a unifying theory of cognitive and emotional learning that broadens the view of what is possible, feasible, and desirable with simulator-based medical education.

The Effect of Gender on the Clinical Clerkship Experiences of Female Medical Students: Results From a Qualitative Study

To characterize how female medical students perceive the role of gender within their medical education during the transition to the clinical curriculum. In 2006-2007, the authors conducted a qualitative study consisting of in-depth interviews with 12 third-year female medical students completing their first clinical clerkship. Participants were purposefully selected from a single New England medical school to represent a range of ages, ethnicities, and prior life experiences. Participants (1) struggled to define their role on the wards and often defaulted to stereotypical gender roles, (2) perceived differences in the nature of their workplace relationships compared with the nature of male medical students' workplace relationships, (3) had gendered expectations of male and female physicians that shaped their interactions with clinical supervisors, (4) felt able to negotiate uncomfortable situations with patients but felt unable to negotiate uncomfortable situations with supervisors and attendings, and (5) encountered a "gender learning curve" on the wards that began to shape their self-view as future female physicians. Despite increased numbers of women in medicine, issues of gender continue to have a substantial impact on the medical education of female students. Institutions can design interventions about gender issues in medicine that expand beyond a focus on sexual harassment to address the complex ways in which students are affected by issues of gender.

‘It's really, really good, but it could be a lot better’: Qualitative evaluation of a Rural Clinical School, four years on

Introduction: In their first clinical year 25% of Western Australia's medical students undertake a clinical longitudinal integrated clerkship in rural and remote Western Australia. Annual evaluations are undertaken.Method: All students, academic and administrative staff employed by the university were interviewed. Qualitative analysis of interview data was taken, fed back to the coordinators and modifications for the next annual cycle were then discussed and decided upon.Results: The predominant themes were elation at the excellence of much of their rural experience and frustration at some individual sites because of issues which were not being resolved. Students were overwhelmingly positive in their interpretation of problems seeing them as systems issue to be improved. Staff at some sites, however, had a strong tendency to blame the student and not respond to the actual problem. All students passed their end of year examinations.Discussion: Most academic evaluation of courses has focussed on comparative academic results with less, if any, attention paid to the qualitative experience of students. Not all clinical clerkship experiences are positive and it is useful to identify what works and what does not work in any medical school. Staff defensiveness is a well-recognised response to challenges and an evaluation system which encourages staff development is an essential component to any School's ongoing improvement.

Too Little Time to Teach? Medical Student Education and the Resident Work-Hour Restriction

The purpose of this study was to examine the impact of the resident duty-hour restriction on medical student education through a survey of faculty, residents, and interns, with interns providing experience as students relative to implementation of work-hour restrictions. A survey was performed at two (one military and one civilian) obstetrics and gynecology residency programs. Additional surveys were obtained from an Association of Professors of Gynecology and Obstetrics workshop, which included military and nonmilitary attendees. The majority of faculty reported spending 5 to 10 hours per week in medical education before and after implementation of the work-hour restriction. Residents reported less time teaching students after work-hour restrictions were instituted. Nearly all interns, responding about their clinical clerkship experience as students, believed their educational experience would have been improved if residents were more involved in teaching. This pilot study suggests residents are less involved in medical student education following implementation of the duty-hour restrictions.

Neurology/Psychiatry Clerkship Cases: “I Need More Vicodin!”

Abstract Introduction This web-based module, required for all neurology-psychiatry clerkship students, is designed to supplement the clinical clerkship experience and address core clerkship objecti...

The Reading Habits of Medicine Clerks at One Medical School: Frequency, Usefulness, and Difficulties

To describe the reading habits of medicine clerks, which previously have not been well described. Understanding issues related to student reading habits may provide insights and opportunities for medical educators to develop methods to improve clerks' clinical clerkship experiences and their information literacy skills. The authors administered an 18-item survey tool to 120 students on their first inpatient internal medicine clerkships at the Johns Hopkins University School of Medicine in 2002-03. The questionnaire focused on issues related to what and how often they read during their basic medicine clerkship. Data were explored mainly with descriptive statistics. One hundred twelve of 120 (93%) medicine clerks completed the survey. Clerks reported reading for an average of 10.8 (SD 5.6) hours per week (median ten hours per week, range one to 30 hours per week). The most commonly used and useful reading sources were UpToDate and test preparation textbooks. Approximately 30% of students reported substantial problems in reading about their patients. Limited data suggest that reading habits and learning methods vary by year of medical school. Clerks are given disparate advice on appropriate reading sources to consult by attending physicians, resident physicians, and fellow students. Students spend significant amounts of time reading online sources during their medicine clerkship, especially UpToDate. Medical educators should become familiar with these sources and contribute to maximizing their effectiveness for students. Additional research focused on understanding how students build skills in information literacy and how educational programs can facilitate the development of those skills is needed.

A Pilot Survey of Patient-Initiated Assaults on Medical Students During Clinical Clerkship

To assess the incidents of patient-initiated assault (PIA) against clinical clerks during the first six months of clinical clerkship. To characterise the assaults with respect to service, location, clerk gender, patient gender. To examine the students' perceptions of the reporting process for PIA. A brief email survey was sent to all third year medical students after six months of clinical clerkship experience. Students were asked to describe assault experiences including: location, service, patient gender and injuries sustained. Six students reported experiencing physical assault in the first six months of clerkship. Assaults occurred on psychiatry (4) and internal medicine (2) services. Two of the assaults took place during consultations in the emergency department. All students reported having pre-clerkship training in management of violent situations. No students were aware of PIA reporting protocols for their hospital. Clinical clerks are at risk of PIA during their training. Students experiencing PIA feel that current levels of pre-clerkship training do not adequately inform them of the resources available after such an incident. These findings underline the need for PIA programs in the undergraduate curriculum including preclerkship training and clear, institution-wide reporting guidelines.

Effect of clinical clerkship on students’ attitudes toward medical learning in Japan: a case study at Kinki University School of Medicine

A 20-item questionnaire was administered to 253 physicians and 111 medical students, who did not have previous clinical clerkship experience, upon completion of their clinical clerkship. Medical students responded that they enjoyed their clinical clerkships but felt pressured and physically tired. Ninety percent of these medical students developed expectations for their career choice during their clinical clerkship. Only 18% of physicians felt that they allowed students enough chance to participate in clinical practice. We must emphasize that the success of any clinical clerkship system depends on an effective communication system between physicians and medical students.

Clinical Clerkships in Neurosurgery and Neurology at United States Medical Schools

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship: however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to take a clerkship and. consequently. had greater numbers of students taking a clerkship in the corresponding specialty. For the 13 medical schools with the two clerkships linked as alternatives, there was a larger ratio of neurosurgery to neurology students than in schools that did not link the two clerkships. For the seven schools with combined clerkships, the average time spent on either service and especially that spent on neurosurgery was decreased relative to schools in which required clerkships were not combined. Externships were much more common at schools with a residency training program in that specialty than in those without. Some potentially generalizable features of clinical clerkships are recorded. (Neurosurgery 29:624-628. 1991)

Clinical clerkships in neurosurgery and neurology at United States medical schools

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship; however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Differences in the clinical clerkship experience of female and male students.

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