Clerkship Directors In Internal Medicine Research Articles

Primer to the Internal Medicine Subinternship

OPEN ACCESSNovember 29, 2012Primer to the Internal Medicine Subinternship Heather E. Harrell, MD, FACP, Meenakshy K. Aiyer, MD, FACP, Joel L. Appel, DO, FACP, Peter M. Gliatto, MD, Michelle L. Sweet, MD Heather E. Harrell, MD, FACP University of Florida College of Medicine Google Scholar More articles by this author , Meenakshy K. Aiyer, MD, FACP University of Illinois College of Medicine Google Scholar More articles by this author , Joel L. Appel, DO, FACP Wayne State University Google Scholar More articles by this author , Peter M. Gliatto, MD The Mount Sinai Hospital Google Scholar More articles by this author , Michelle L. Sweet, MD Rush University Medical Center Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9277 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis resource is a 59-page guide that is meant to be used as a stand-alone primer for subinterns and interns in internal medicine. This resource can also be adapted for pediatric, family medicine, and surgical subinterns and interns. The primer is divided into sections covering how to make the most of a subinternship, working in the health care team, advanced communication skills, transitions of care, and practical nuts and bolts. The work is multi-institutional and supported by Clerkship Directors of Internal Medicine, the national organization representing clerkship and subinternship directors in internal medicine. This primer was developed to provide standardized and, when available, evidenced-based guidance for performing practical tasks of internship that are frequently overlooked in traditional medical school curricula. It can be distributed in paper form or as an electronic link during the subinternship and internship orientations. It can also be used to provide examples and/or reinforce concepts presented at related teaching conferences conducted at the local medical school or residency program. The major limitation is the lack of published evidence to support best practices in many of the areas covered in the primer. While other topics, such as time management and conflict negotiation, have a preponderance of resources, these brief distillations are by necessity an oversimplification. Though 15 major academic institutions are represented in this primer, these guidelines were not vetted at all medical schools and may be at variance with certain local standards. Although the chapters are relevant to interns in all specialties, a minor limitation is that many of the examples are specific to internal medicine. Subinternship or program directors in specialties outside of internal medicine may want to adapt the examples to their specialty. Educational Objectives The goal of this resource is to provide standardized and, when available, evidenced-based guidance for performing practical tasks of internship that are frequently overlooked in traditional medical school curricula. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx SubIPrimer.docx To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationHarrell HE, Aiyer MK, Appel JL, Gliatto PM, Sweet ML. Primer to the Internal Medicine Subinternship. MedEdPORTAL. 2012;8:9277. https://doi.org/10.15766/mep_2374-8265.9277 Copyright & Permissions© 2012 Harrell et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsTime ManagementSubinternshipHandoffsPractical Duties Disclosures None to report. Funding/Support None to report. Loading ...

Hospital medicine in the internal medicine clerkship: Results from a national survey

Hospital medicine is growing rapidly. This changing inpatient work force has had consequences on medical education, with an increasing hospitalist presence in resident and student training. Initially met with apprehension, there is growing literature to suggest that hospitalists are perceived to be more effective clinical teachers than non-hospitalists. However, the extent to which hospitalists are involved in teaching Internal Medicine (IM) to medical students is not known. In order to determine the role of hospitalists in medical student education within the United States and Canada, we queried clerkship directors in Internal Medicine as part of the 2010 annual Clerkship Directors in Internal Medicine (CDIM) survey. In June 2010, CDIM surveyed its North American institutional members, which represent 110 of 143 Departments of Medicine in the US and Canada. Eight-two of 107 departments responded to the survey (77%). Seventy-five (91%) indicated that hospitalists served as teaching attendings at their teaching hospital. In twenty-two (27%) IM departments, 75% to 100% of students rotate with a hospitalist during their IM clerkships. Thirty-three (42%) departments report that students are directly supervised by in-house hospitalists during their nighttime call requirements. Sixty-six (81%) indicated that academic hospitalists hold educational administrative positions. Hospitalists are significantly less likely to have additional clinical commitment as compared to non-hospitalist teaching attendings (16% vs 53%, (χ 21df = 33.1; P < 0.0001). Hospitalists are involved in medical student education in the large majority of Departments of Internal Medicine throughout the US and Canada, reflecting the growth of hospital medicine nationally.

Abstracts From the Proceedings of the 2011 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

The mission of Clerkship Directors in Internal Medicine (CDIM) is to promote excellence in medical student internal medicine education. The organization represents course directors, site directors, and program administrators. CDIM is a member of the Alliance for Academic Internal Medicine, a consortium of five academically focused specialty organizations representing departments of internal medicine, at medical schools and teaching hospitals in the United States and Canada. At Academic Internal Medicine Week 2011 in Anaheim, California, CDIM held its annual meeting at which oral abstracts and posters were presented. Selected by the CDIM Research Committee, the abstracts highlight CDIM members’ innovation and careful appraisal of the medical student experience. Three abstracts address the changing climate in medical education by clarifying medical students’ clerkship experiences with hospitalists, assessing their role at medical emergencies, and presenting evidence that the physical examination is receiving less attention. Two abstracts address improving evaluation and feedback skills of the faculty and residents responsible for student teaching. Additional selected abstracts highlight curricular innovations including the use of game theory to teach students about cost, geriatrics home visits, and enhancement of the sub-internship. A novel clerkship was created to allow students’ exposure to continuity of care. Finally, clerkship administrators share an effective approach to enhance collaboration. These abstracts were identified by CDIM as the highest quality and most relevant for medical student educators and the readership of Teaching and Learning in Medicine.

How and Why Internal Medicine Clerkship Directors Use Locally Developed, Faculty-Written Examinations

To describe how and why internal medicine clerkship directors (CDs) use locally developed, faculty-written (LFW) examinations. In 2009, the Clerkship Directors in Internal Medicine conducted an annual, online, confidential survey of its 107 U.S. and Canadian institutional members, including questions about LFW examinations. Data were analyzed using descriptive statistics and coding of free text. Sixty-nine of 107 members (64.5%) responded. The National Board of Medical Examiners (NBME) examination was administered by 93% (63/68), LFW examinations were used by 33% (22/67), and both types were used by 22% (17/67)-compared with 85%, 36%, and 12% in 2005. LFW examinations were frequently created by the CD alone (9/22; 41%) and consisted of one test (12/22; 52.2%), but some schools gave two (6/22; 26.1%), three (2/22; 8.6%), or four or more (3/22; 13%). Multiple-choice examinations were most common (26/38; 68.4%), followed by short-answer (8/38; 21.1%) and essay (4/38; 10.5%). Most were graded using preestablished criteria; half required a minimum passing score (60% most common). LFW exams were most commonly 5% to 10% of the total grade. Only a minority of CDs reported having reliability estimates or a control group for their exams. Most (70%) reported using LFW exams to cover content felt to be underrepresented by the NBME. Findings strongly suggest that a minority of internal medicine CDs use LFW examinations, mostly to measure achievement not assessed by the NBME. However, validity evidence is not consistently being gathered, which may limit judgments based on exam results.

Reflective Writing in the Internal Medicine Clerkship: A National Survey of Clerkship Directors in Internal Medicine

Background and Purpose: Reflective writing programs have been implemented at many medical schools, but it is unclear to what extent and how they are structured. Methods: We surveyed the 107 Clerkship Directors of Internal Medicine member institutions on use of reflective writing assignments during the internal medicine clerkship. Results: Eighty-six of 107 (80%) institutional members completed the survey. Thirty-five percent reported having a reflective writing assignment, 48% did not, and 6% did not but were considering starting one within the next 2 years. Of the 30 assignments, most were partially structured (60%), involved small-group discussion (57%), and provided individual student feedback (73%). A minority (30%) contributed to the students’ grade. Respondents believed assignments contributed to students’ learning in multiple domains, most often Professionalism (97%) and Communication (77%). Conclusions: Although reflective writing programs were common, variability existed in their structure. Further research is needed to determine how best to implement them.

To Friend or Not to Friend? Social Networking and Faculty Perceptions of Online Professionalism

To assess faculty perceptions of professional boundaries and trainee-posted content on social networking sites (SNS). In June 2010, the Clerkship Directors in Internal Medicine conducted its annual survey of U.S. and Canadian member institutions. The survey included sections on demographics and social networking. The authors used descriptive statistics and tests of association to analyze the Likert scale responses and qualitatively analyzed the free-text responses. Of 110 institutional members, 82 (75%) responded to the survey. Of the 40 respondents who reported current or past SNS use, 21 (53%) reported receiving a "friend request" from a current student and 25 (63%) from a current resident. Of these, 4 (19%) accepted the student request and 12 (48%) accepted the resident request. Sixty-three of 80 (79%) felt it was inappropriate to send a friend request to a current student, 61 (76%) to accept a current student's request, 42 (53%) to become friends with a current resident, and 61 (81%) to become friends with a current patient. Becoming friends with a former student, former resident, or colleague was perceived as more appropriate. Younger respondents were less likely to deem specific student behaviors inappropriate (odds ratio [OR] 0.18-0.79; adjusted OR 0.12-0.86, controlling for respondents' sex, rank, and SNS use), although none reached statistical significance. Some internal medicine educators are using SNSs and interacting with trainees online. Their perceptions on the appropriateness of social networking behaviors provide some consensus for professional boundaries between faculty and trainees in the digital world.

Analysis and Publication Rates of Clerkship Directors in Internal Medicine (CDIM) Annual Meeting Abstracts 1995–2005

Background: s presented at meetings may be a reflection of the meeting's quality. Summary: The goal is to determine purpose, content areas, research design, and subsequent publication rates of abstracts presented at Clerkship Directors in Internal Medicine's annual meetings. s presented in 1995–2005 were analyzed. A total of 201 abstracts were analyzed and coded. The purpose of the majority of the studies was description (155, 77%), 44 (22%) were justification studies, and 2 (1%) were clarification studies. In all, 109 (54%) assessed the relationship between teaching and student performance. Seven (4%) were studies about how students learn, study, solve problems, obtain medical knowledge, and think critically. Nineteen (10%) were studies about students’ noncognitive skills, professionalism, interpersonal skills, and well-being studies. In all, 29 (14%) were measurement studies assessing reliability or validity of assessments. Twenty (10%) focused on career or faculty development pertaining to either faculty or residents. Research design of most studies was descriptive or pre-experimental (175, 87%), some were quasi-experimental (13, 7%), and two thirds (135, 66%) were not published as full articles in peer-reviewed journals. and there was an upward trend in publication rates. Conclusions: These findings may serve as an indicator of the quality of the educational meeting. It may further stimulate efforts to develop programs to help program attendees achieve scholarly publications for work presented and serve as a benchmark against which future meetings may be judged.

Journal Watch From CDIM (Clerkship Directors in Internal Medicine) Review of Medical Education Articles in Internal Medicine, 2009–2010

This journal watch feature sponsored by the Alliance for Clinical Education provides brief summaries of selected medical education articles that were published in internal medicine specialty journa...

Simulation in the Internal Medicine Clerkship: A National Survey of Internal Medicine Clerkship Directors

Background: Simulation in medical education offers the promise of safely and effectively preparing trainees for a variety of tasks encountered in clinical medicine. Purpose: The objective was to determine internal medicine (IM) clerkship directors’ perceptions of the use of simulations during the medicine clerkship. Methods: A cross-sectional survey of 110 Clerkship Directors in Internal Medicine (CDIM) institutional members was presented. The survey contained 24 questions including multiple-choice responses with Likert scale and open-ended questions. Descriptive and correlational statistical analyses were performed. A thematic qualitative analysis was performed. Results: Response rate was 78% (86/110). Simulation was used in the IM clerkship in 84% (72) of responding schools. Simulations were used to teach a variety of clinical skills and concepts such as history taking and diagnostic reasoning. The intended goal of simulations was teaching in 39% (28), formative assessment in 49% (35), summative assessment in 38% (27), and compliance with Liaison Council for Medical Education requirements in 19% (14). Most of clerkships (54%, 49) use standardized patients, with 37.5 % (27) using them for formative purposes, whereas 33% (24) used them for summative purposes. Support for simulation was provided by the school of medicine in 57% (41) of clerkships, by the department of medicine in 30% (22) of clerkships. Conclusions: Simulations are used to teach clinical skills and for formative and summative assessments. Standardized patients and simulation mannequins are the most commonly used simulations types. Further research is needed to assess clerkship directors’ needs, knowledge, and use of simulation in specific learning and training contexts.

Abstracts from the Proceedings of the 2010 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

Abstracts from the Proceedings of the 2010 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

AAIM Report on Master Teachers and Clinician Educators, Part 5: Academic Documentation and Tenure

The Alliance for Academic Internal Medicine (AAIM) is composed of key internal medicine-based professional bodies committed to the preservation, growth, and refinement of the specialty. Member organizations include the Association of Professors of Medicine, the Association of Specialty Professors, the Association of Program Directors in Internal Medicine, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.1 A primary mission of AAIM is to foster change in medical education to best meet the needs of future practitioners, academicians, and leaders in internal medicine.

What Are the Discussion Topics and Usefulness of Clerkship Directorsʼ Meetings Within Medical Schools? A Report From the CDIM 2007 National Survey

To characterize meetings among clerkship directors within medical schools, specifically with regard to topics of discussion, and usefulness of the meetings. In 2007, the Clerkship Directors in Internal Medicine surveyed its institutional members from 114 U.S. and Canadian medical schools. Respondents were asked about the frequency of meetings among clerkship directors, the topics of discussions, whether they were precluded from discussing students in academic difficulty, and the benefits and drawbacks of discussing students' performance. Analysis included descriptive statistics and qualitative analysis of free-text responses. The response rate was 71% (81/114). The most common meeting frequencies were monthly (77%) or quarterly (15%). Topics discussed included deans' policies (91%), general announcements (90%), recommendations from clerkship directors to the dean (86%), Liaison Committee on Medical Education site visit preparation (84%), curricular input (82%), discussion of struggling students (49%), students' progress (48%), and planning for at-risk preclerkship students (22%). Some respondents (16%) were explicitly prevented from discussing student performance, for reasons of possible harm to the student (30/84; 36%), bias developing against the student (13/84; 16%), violation of privacy/lack of student confidentiality (4/84; 5%), and possible bias in grading or evaluation (8/84; 10%). Most respondents (94%) agreed there were benefits to students resulting from discussions: longitudinal tracking of concerns, designing remediation, tailoring teacher assignments, and societal obligations. Clerkship directors meet frequently to discuss curriculum, policy, and students' performance. Most internal medicine clerkship directors believe discussing students' performance helps design educational interventions that balance societal obligations with student confidentiality.

Knowledge and Skills Competencies for the Undergraduate Internal Medicine Curriculum in Saudi Arabia

OPEN ACCESSNovember 15, 2010Knowledge and Skills Competencies for the Undergraduate Internal Medicine Curriculum in Saudi Arabia Hani Almoallim, MD Hani Almoallim, MD Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.8177 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractThis resource contains all of the research used to reconstruct the internal medicine curriculum in at Umm Alqura University in Saudi Arabia. This research can also assist in designing a national guide for internal medicine teaching in medical colleges of Saudi Arabia. It also can be used in designing a clerkship curriculum in internal medicine based on these specified competencies that augment and serve as a continuum of what had been taught in undergraduate curriculum. In this national research project, the knowledge and skills competencies in internal medicine for the undergraduate curriculum were determined and prioritized following a strict research methodology. A group of 20 clinicians rated the identified competencies from 0–3 (0: no need to know, 1: Interesting to Know, 2: Should Know and 3: Must Know). A total of 1514 knowledge competencies and 189 skills competencies were determined and prioritized. The competencies corresponded to 12 systems in internal medicine. This resource was used along with other work from different disciplines, at the institution to design an integrated curriculum where basic scientists and clinicians are sharing the same responsibilities in teaching medicine. This approach will greatly enhance the relevancy of the taught materials to the needs of medical students. The use of this resource should help in determining and specifying clear competencies for courses, curricula, lectures, problem-based learning, and bedside teaching sessions. It can also assist in the design of integrated curriculum that will greatly enhance the relevancy of the taught materials to the needs of medical students. Educational Objectives By the end of this module, the learner will be able to: Determine and prioritize competencies for the undergraduate internal medicine curriculum.Differentiate between important and less important components of undergraduate internal medicine curriculum.Design efficient undergraduate internal medicine curriculum based on clearly identified competencies.Improve quality of teaching of internal medicine by focusing on objectively defined knowledge and skills competencies. ReferencesShumway J.M. and Harden R.M., AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician. Med Teach, 2003. 25(6): p. 569–84. http://dx.doi.org/10.1080/0142159032000151907Medline, Google ScholarReid N., The Delphi Technique: It's Contribution to the Evaluation of Professional practice. Professional Competence and Quality Assurance in the Caring Professions, ed. Ellis R.. 1988, New York: Chapman Hall.Google Scholarde Villiers MR, de Villiers PJ, and Kent AP, The Delphi technique in health sciences education research. Med Teach, 2005. 27(7): p. 639–43. http://dx.doi.org/10.1080/13611260500069947Medline, Google ScholarMyers A.R., NMS Medicine. 2005: Lippincott Williams & Wilkins.Google ScholarTalley NJ, O'Connor S. Clinical Examination. 2005: Wiley-Blackwell.Google ScholarLawrence PF, et al., Determining the content of a surgical curriculum. Surgery. 1983;94(2):309–317.Medline, Google ScholarGoroll AH, et al. Reforming the core clerkship in internal medicine: the SGIM/CDIM Project. Society of General Internal Medicine/Clerkship Directors in Internal Medicine. Ann Intern Med.2001;134(1):30–37. http://dx.doi.org/10.7326/0003-4819-134-1-200101020-00011Medline, Google ScholarBass EB, et al. National survey of Clerkship Directors in Internal Medicine on the competencies that should be addressed in the medicine core clerkship. Am J Med.1997;102(6):564–571. http://dx.doi.org/10.1016/S0002-9343(97)00054-5Medline, Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructor's Guide.docx Diseases Based Ratings [1][1].pdf All competencies 1 of 4 Sheet (0-3)[1].pdf Core Competencies 1 of 4 Sheet (2.2-3)[1].pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2010 Almoallim. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsPBLKnowledge CompetenciesDelphi TechniqueCompetency-Based Education Disclosures None to report. Funding/Support None to report. Loading ...

AAIM Report on Master Teachers and Clinician Educators Part 4: Faculty Role and Scholarship

The Alliance for Academic Internal Medicine (AAIM) is composed of key internal medicine-based professional bodies committed to the preservation, growth, and refinement of the specialty. Member organizations include the Association of Professors of Medicine, the Association of Specialty Professors, the Association of Program Directors in Internal Medicine, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.1 A primary mission of AAIM is to foster change in medical education to best meet the needs of future practitioners, academicians, and leaders in internal medicine.

Abstracts From the Proceedings of the 2009 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

The Clerkship Directors in Internal Medicine (CDIM) is the organization dedicated to medical student education in internal medicine. Its members include educators across the continuum of medical st...

Medicine Clerkships and Portable Computing: A National Survey of Internal Medicine Clerkship Directors

Background: Portable computers are widely used by medical trainees, but there is a lack of data on how these devices are used in clinical education programs. Purposes: The objective is to define the current use of portable computing in internal medicine clerkships and to determine medicine clerkship directors' perceptions of the current value and future importance of portable computing. Methods: A 2006 national survey of institutional members of the Clerkship Directors in Internal Medicine. Results: Eighty-three of 110 (75%) of institutional members responded. An institutional requirement for portable computing was reported by 32 schools (39%), whereas only 13 (16%) provided students with a portable computer. Between 10 and 31 institutions (12–37%) reported student use for patient care activities (i.e. order entry, writing patient notes) and only 2 to 4 institutions (2–5%) required such use. The majority of respondents (59–95%) reported portable computer use for educational activities (i.e., tracking patient problems, knowledge resource), however, only in 5 to 19 (6–23%) were such educational uses required. Fifty-six respondents (68%) reported that portable computer's “added value” for teaching and 61 (73%) reported that portable computers would be important in meeting clerkship objectives in the next 3 years. Of interest, even among the institutions requiring portable computers, only 50% recommended or required specific software. Conclusions: Portable computing is required at 39% of allopathic medical schools in the United States. However required portable computing for specific patient care or educational tasks is uncommon. In addition, guidance on specific software exists in only one half of school requiring portable computers, suggesting informal or unstructured uses of required portable computer's in the remaining half. The educational impact of formal institutional requirements for software versus informal “user-defined” applications is unknown.

Patient Safety Education at U.S. and Canadian Medical Schools: Results From the 2006 Clerkship Directors in Internal Medicine Survey

To describe current patient safety curricula at U.S. and Canadian medical schools and identify factors associated with adoption of these programs. A survey was mailed to institutional members of the Clerkship Directors in Internal Medicine at U.S. and Canadian academic medical schools in 2006. Respondents self-reported implementation of patient safety curricula and associated methods of instruction at the institution level. The survey had a 76% response rate (83/110). Only 25% of institutional members reported that their schools had explicit patient safety curricula. All respondents that reported having curricula use lectures and small-group instruction, and these were more likely to occur in preclinical settings. Topics and methods of instruction included reporting adverse incidents and analysis of medical errors; improvement of physician order writing to prevent medication errors; core measures; national patient safety goals; and standardization of medical care through the use of clinical guidelines and order set templates. Although only 25% of respondents reported having explicit curricula, 72% agreed that patient safety instruction should occur during medical school. Despite calls from regulatory, medical, and educational organizations to increase patient safety training of medical students, internal medicine clerkship directors report that few schools in the United States and Canada have implemented specific patient safety curricula. Most existing patient safety curricula use lecture and small-group discussion as preferred methods of instruction.

Internal Medicine Core Clerkships Experience With Core Problem Lists: Results From a National Survey of Clerkship Directors in Internal Medicine

Background: The Liaison Committee on Medical Education (LCME) requires clinical clerkships in North American Medical Schools to define and monitor core problems and clinical conditions for medical students and adjust the clerkships to ensure that all students meet those objectives at all instructional sites. Clinical clerkships usually use medical student generated logbooks to meet these requirements. It is not clear what clinical clerkship directors are doing to meet these standards. Purpose: To determine how internal medicine clerkship directors develop problem lists, whether and how they verify student problem list entry, and how missed core problems are covered. Methods: The Clerkship Directors in Internal Medicine (CDIM) organization conducts an annual survey of its institutional members (one member per medical school). In 2007, 75% of North American medical schools (82 of 110) responded to the survey, which included questions on core problem lists and medical student logbooks. Results: Ninety-four percent of responding medical schools had a core problem list for the core internal medicine clerkship. Most schools used an electronic logbook and verified student exposure to core problems (76%). The clerkship director usually did the verification (63%). Clerkships offered a variety of options to remedy lack of exposure to core problems and usually offered more than one option. Conclusions: Clerkship directors in internal medicine develop, verify, and ensure exposure to core problems in internal medicine. Most clerkship directors used the CDIM recommended core problem list as a basis for their local core problem list. Emerging computer-assisted learning options may simplify clerkship adjustments for lack of exposure to core problems. It appears that clerkship directors are using logbooks appropriately to meet the LCME charge to monitor core problems and clinical conditions.

Using Patient Encounter Logs for Mandated Clinical Encounters in an Internal Medicine Clerkship

Background: Patient encounter logs help assess a student's educational experience. The use of a grading incentive linked to the mandatory documentation of prespecified clinical encounters has been insufficiently studied. Purposes: Given this, our objectives were to determine (a) if mandating student exposure to patients with 18 key training problems leads to the successful documentation of these encounters, (b) the degree of difficulty students and clerkship directors experienced in meeting these mandates, (c) the accuracy of mandated log entries, and (d) how often the log entries were questioned or rejected by preceptors. Methods: Ninety-two 3rd-year internal medicine students and 6 internal medicine clerkship directors at 9 geographically dispersed hospitals and 30 ambulatory sites participated in the study. Over a single academic year, we directly measured the completion rate of mandated logs, the degree of their accuracy as judged against faculty-generated logs of two required videotaped standardized patient encounters, and the percentage of logs that were not validated. We surveyed students and directors on the perceived degree of difficulty in meeting mandated requirements. Results: Ninety-eight percent of students met our mandated requirements and 93.8% of students found it “easy” or “very easy” to meet this requirement. The amount of estimated time spent by clerkship directors helping students meet mandated requirements for the entire year was 4.5 hr. The accuracy of submitted logs was 77%; however, almost all inaccurate log entries were “validated” by preceptors. Conclusions: Mandating encounters is effective in assuring that students document encounters with patients who present with specific clinical problems. The accuracy of our students' mandated logs is similar to previously published data. However, even inaccurate logs were rarely questioned or rejected by preceptors.

Readdressing the Need for Consensus in Preclinical Education

Clinical skills are often taught in preclinical courses such as "Introduction to Clinical Medicine" (ICM). We sought to define current national course objectives, roles of standardized and real patients, and methods of assessment in ICM courses, and to readdress the need and desire for establishing consensus. In April 2005, the Clerkship Directors in Internal Medicine (CDIM) organization conducted its annual, voluntary, and confidential survey. The survey contained a section (24 questions) on preclinical education teaching methods and evaluations. Wide variations exist in the teaching and assessment methods used by ICM courses in 4-year medical schools. Respondents indicated a desire for a consensus statement concerning ICM course objectives in addition to guidance on case development, use of standardized patients, and student assessments. Our findings suggest that consensus remains elusive for preclinical education teaching objectives, but would be embraced by ICM course directors.