Medical Clerkship Research Articles

Comparison of the Effectiveness of Two Lecture Methods in an OB/GYN Clerkship

DOI: http://dx.doi.org/10.5915/39-4-8525 Background: A structured, consistent, didactic lecture system is extremely important in a third-year medical clerkship. Yet, its development for the obstetrics/ gynecology (OB/GYN) program is challenging for many reasons. Development of a system that is less dependent on a given lecturer's availability yet still provides complete coverage of the Association of Professors of Gynecology and Obstetrics (APGO) topics for third-year students is desirable. Objective: The present study was designed to compare the effectiveness on third-year OB/GYN medical students of live lectures versus lectures previously recorded to a compact disc. Outcome measures were a midterm internal examination and the National Board of Medical Examiners (NBME) examination scores at the end of the clerkship. Experimental Design: Third-year medical students were assigned by lottery either to the Medical College of Georgia (MCG) campus in Augusta, Georgia, or one its several community-based sites (CBSs) throughout the state of Georgia. All third-year clerkship lectures given by different instructors were videotaped and saved to a compact disc to be played at all CBSs. The students at CBSs were required to observe the lectures in the same order as the live lectures were delivered to students at the MCG campus in Augusta. Results: Student performance on the midterm internal exam and on the NBME examination was compared between the MCG campus and CBSs. Results are shown as raw score mean (SD). Midterm results showed: MCG was 65.6 (8.7) and CBS was 70.4 (17.0). NBME results showed: MCG was 81.1 (6.3) and CBS was 82.2 (7.6). Conclusion: Using examination scores as the outcome, our preliminary data suggest there may be no significant difference in performance on the shelf exam between students receiving a live lecture versus students observing the same lecture electronically.

Medical Student Emergency Medicine Clerkship Satisfaction Improves with the Addition of a Limited Number of Dedicated Faculty Teaching Shifts

Medical Student Emergency Medicine Clerkship Satisfaction Improves with the Addition of a Limited Number of Dedicated Faculty Teaching Shifts

Internal Medicine Clerkship Directors' Opinion Regarding Clinical Input in the Preclinical Years:The 2002 CDIM Basic Science Survey Results

Background: Input from both basic science and clinical faculty members is needed to promote further integration of medical curricula.Purpose: To assess current views of clerkship directors about the role and relationship of the basic sciences to clinical years in medical education.Methods: As part of the 2002 Annual CDIM Survey, questions regarding basic science curriculum were included; 89 of 123 CDIM members responded (72%).Results: Overall, respondents felt participation from both basic science and clinical faculty members is necessary to define basic science course content. Nearly 89% of clerkship directors indicated curricular review should be collaborative and interdepartmental; 93% felt that this review effort should occur frequently. Supporting the growing philosophy that the structure of the preclinical years should involve increased clinically relevant integration, 58% favored an integrated organ system approach rather than the traditional departmental structure (18%). In addition, in order of ranking, respondents felt that small group (M = 2.0 ± 0.9) and problem-based learning (M = 2.1 ± 1.1) are better approaches than the standard lecture format (M = 2.8 ± 1.2). Although clerkship directors recognized the need for increased clinical input in the preclinical years, many reported a lack of knowledge regarding the amount of clinical exposure students received in the basic science years (33%), frequency of peer review of the basic science courses (20%), and who performed peer review of the basic science courses at their institution (36%).Conclusion: Medical clerkship directors believe that basic science education should be developed collaboratively, organized by organ system, and presented in small groups.

Web-based evaluation of medical clerkships: a new approach to immediacy and efficacy of feedback and assessment

The classical assessment of medical students has been based on the 'apprenticeship' model, which consists of written examinations and tutor-led assessment of coursework; this method has proved to be very dependent on tutors' attitudes and instructional skills and on patients' availability. This paradigm has shifted in recent years as a result of the new implementation of modular assessments, logbooks and portfolios during clerkship rotations. Portfolios have been demonstrated to be a very useful tool to promote self-reflection, prompt feedback and skills development. However, written portfolios not only introduce additional paperwork for both students and tutors but also have some limitations for immediacy and effectiveness of feedback. To obviate these limitations an electronic portfolio is proposed here to be used by students and tutors during clinical clerkships. Based on the principles for good practice in undergraduate education the authors show the advantages of this method and its multiple applications to promote students' development of skills and attitudes and to improve tutors' acceptance of this innovative evaluation method.

Longitudinal effectiveness of a medical school geriatrics clerkship

Longitudinal effectiveness of a medical school geriatrics clerkship

Removing rater effects from medical clerkship evaluations.

Removing rater effects from medical clerkship evaluations.

Students' educational activities during clerkship.

To quantify the educational activities and types of teachers that medical students had in third-year clerkships at community-based teaching hospitals. In October-November 1992, 201 students in third-year medical clerkships at nine community-based hospitals completed a log that recorded the primary activity, site, and educator and method of education (for teaching or supervised activities) for each 15-minute interval of a 24-hour day. Each hospital offered at least three of the clerkships studied: medicine, obstetrics-gynecology (ob-gyn), pediatrics, psychiatry, and surgery. Statistical comparisons of the clerkships were done with chi-square analysis and one-way analysis of variance. The students received 6.5 hours a day of teaching with an instructor and committed an additional 4.9 hours to clerkship-related learning. Nearly 75% of the teaching fell to full-time faculty members and residents. In just over half of their educational activities the students participated with other learners, such as residents. The clerkships did not differ significantly in the amounts of formal teaching given; however, medicine did significantly more informal teaching, and surgery and ob-gyn did significantly more supervised practice. This preliminary study quantified medical students' educational activities in 1992 during third-year clerkships and provides baseline data describing these activities and the educators involved. Some findings may not be replicable, however, with the increasing demands of full-time faculty members in inpatient and outpatient settings and the shifting emphases in how and where residents provide instruction. Another study such as this one would help assess the effects on medical education of changes in the health care environment.

Are learning objectives useful in evaluating medical school course and instructor performance?

We tested the hypothesis that learning objectives could be used to evaluate course and instructor effectiveness. Ninety-seven third-year medical students who had their surgical clerkship or their medical clerkship as their first clinical rotation were compared. The surgery clerks received 171 urologic learning objectives. Students taking the surgical clerkship had significantly higher postclerkship recognition of the learning objectives than did medical clerkship students. One year later, these students were again surveyed to determine whether they still knew the correct response to the learning objective. The follow-up survey showed that 50% of the students recognized objectives covered in five of the eight urology lectures, while the other lectures were not effective. Students who recognized the objective on the postclerkship evaluation were more likely to think the objective had been taught on this follow-up survey. These data suggest that learning objectives are useful for evaluating course and instructor effectiveness.

Relation of the internal medicine residency and the medical school curriculum.

Students should have contact with faculty members in internal medicine throughout their medical education. Faculty internists should play a role in admission of students, in the basic science courses of the first year of medical school, and in the introductory course to clinical medicine and pathophysiology of the second year of medical school. The core medical clerkship is not an academic advertisement and should not be designed specifically to attract students to internal medicine. The core clerkship is designed for all students, regardless of their intended specialty and should include inpatient and outpatient care in a context and at a pace that allow time for reflection, reading, and problem solving. The advanced medicine experience should give students at least a glimpse of the mastery of the discipline of internal medicine. For students entering internal medicine, the fourth year of medical school and first year of residency could be combined to improve the content and quality of both.

Achievement of objectives: internal medicine fourth year clinical clerkship

The clinical clerkship in Canadian Medical Schools is intended to provide senior medical students with opportunities to gain practical knowledge of clinical medicine, develop technical skills, learn to use judgement and experience first-hand clinical decision making. Assessment of rotations in internal medicine were undertaken in order to understand more fully the nature of medical clerkship experiences. We found that medical clerks in our programme were exposed to a high proportion of undifferentiated problems and an adequate case mix. They performed a wide range of technical procedures. There were, however, certain gaps in the clerks' experiences both in the specialty areas, and in therapeutic and technical procedures. Recognition of these gaps in the clerkship experiences suggest that further deliberation of goals and objectives is required and issues of achievement of competencies need to be addressed.

Reliability of global rating scales in the assessment of clinical competence of medical students.

Undergraduate medical students of the Ben Gurion University were evaluated upon completion of their fourth- and sixth-year medical clerkships by a 17-item rating scale, a multiple choice question (MCQ) test and a patient-oriented oral examination by two academic staff members. Pearson's correlation coefficient between the fourth-and sixth-year global ratings was r = 0.44 (P less than or equal to 0.001), while that between the fourth- and sixth-year MCQ scores was r = 0.54 P less than or equal to 0.001). Pearson's coefficient between the global ratings and the MCQ scores in the sixth year was r = 0.25 (P less than or equal to 0.05). Stepwise regression analysis revealed that the ratings on the parameters 'reliability', 'knowledge', 'organization', 'diligence' and 'case presentation' were the most predictive of the overall global rating. It is concluded that the reproducibility of 'subjective' expert assessment of performance through global rating scales is comparable to that of 'objective' evaluation through written MCQ, even though these measures assess different domains of competence at different levels of simulations. It is recommended that the clinical performance of undergraduate medical students should be assessed by a combination of subjective and objective measures.

The medical clerkship.

In the past 40 years, the teaching of clinical medicine has changed greatly, but so gradually that only a dwindling number of medical educators can recall from their own experience the character of...

Human values teaching programs in the clinical education of medical students.

Medical school deans and faculty members were surveyed by the Association of American Medical Colleges to obtain information on 1984-85 courses designed to improve students' ability to examine their values in relation to those of patients, communicate effectively with patients, or think critically about cultural, social, and ethical issues arising in medical care. Of the 126 deans contacted, 113 supplied course descriptions, and 99 responded to survey questions about the integration of human values programs into students' clinical education. Ninety-five schools reported that at least one human values course was required during the first or second year of the curriculum; 38 schools listed a program as part of the required curriculum for the third or fourth year. The respondents reported several ways in which human values programs were integrated into clinical education. The most frequently mentioned method was reinforcement or addition of human values emphases during medical clerkships. The process considered to be most important by respondents in achieving this integration was a combination of interactions among faculty members, improvement of human values courses, and the support of the dean. The respondents also reported on the characteristics of faculty members who teach such courses, on faculty development efforts, on barriers to the integration of human values teaching into the curriculum, and on the evaluation of such courses.

The validity of clerkship performance evaluations.

The validity of narrative evaluations of clinical performance in medical school was investigated for three successive classes of medical school graduates. The criteria were ratings obtained from residency supervisors one year after entering the programme. Bivariate correlational analysis, multiple regression analysis and canonical redundancy analysis were performed to examine the associations between the evaluations by teachers of competence in medical school clerkships and the subsequent ratings by residency supervisors. The results, best summarized in the canonical analysis, showed two relationships between the two sets of measures (lambda 1 = 0.54 and lambda 2 = 0.47). The first relationship revealed an overall-competence-in-medicine dimension; the second suggested an interpersonal-skills/professional-maturity dimension. Overall, knowledge of clerkship performance accounted for 15% of the variance in residency ratings. The findings suggest the need to improve the assessment of professional maturity and behaviour during medical school.

The role of the student ward in the medical clerkships.

The authors describe the structure and the development of an internal medicine clerkship designed to promote proficiency in the process of clinical reasoning. The clerkship is centered around a "student ward" in which the student assumes the role of primary physician. The environment provides not only close supervision and counsel but also allows a great deal of autonomy as students embark on their first clinical medicine rotation. The student ward offers a structured environment where the emphasis is on in-depth clinical exposure and the acquisition of clinical knowledge in a manner consistent with the principles of problem-based learning. Breadth of clinical exposure is accomplished through a variety of educational approaches.

Medical Student Education in Advanced Cardiac Life Support

A standardized approach to advanced cardiac life support (ACLS) improves the morbidity and mortality from cardiac arrest. Physicians should receive formal training, certification, and periodic recertification in ACLS. This paper describes the system we have developed to provide all the medical graduates of our university with training and American Heart Association (AHA) certification in ACLS.MethodThe course takes place during the third year of medical school in four afternoons during the students' medical clerkship. The students are required to take this course and are freed from all other commitments during these afternoons. Several weeks before the course, the students are given a brief introductory lecture, registered, and strongly encouraged to read the AHA manual for providers of advanced cardiac life support.

Computers in Health Science Education: Communication and Management

An automated health science university is characterized through a description of a teaching physician's interaction with his networked microcomputer. Progress towards instructional automation is explored at Rush University and the University of Illinois with an emphasis on an electronic logbook and evaluation system for medical clerkship and residency programs. This joint development project is presented as an intermediate stage in automation. Its use is contrasted to traditional computer based education, and shown to fill pressing needs in medical education.

Six-year documentation of the easy grader in the medical clerkship setting.

Six-year documentation of the easy grader in the medical clerkship setting.

Assessment of Students' experiences in technical procedures in a medical clerkship

This study was designed to provide some insight into the manner and degree of students' acquisition of practical skills. One hundred and fifty-two of a total of 166 students in a medical clerkship during the first clinical year answered a questionnaire. The questionnaire contained fifty-eight different laboratory tests and technical procedures. The study revealed deficiencies in the teaching programme. On the average the students had been exposed to 19.4 procedures during their 13-week clerkship. We found no differences according to sex or age. Fourteen skills were considered mandatory. The mean result was 62% for these procedures. Urine analysis and participating in evening rounds gained best scores, while test for blood in faeces and discussing insulin dosage had the lowest scores, 14% and 10% respectively. In order to increase the amount of exposure to practical skills, some improvements in the teaching programme are suggested.

The emergency room as a clerkship site.

The psychiatric emergency room of a county hospital is one of five clinical placement sites for the authors' medical school junior clerkship. The students assigned to the emergency room share the same core didactic work as students who are placed at more traditional sites, but the emergency room students have additional seminars in crisis intervention, aspects of emergency psychiatry, and orientation to social agencies. Analysis of data measuring the achievement of behavioral objectives common to all five clinical sites shows that emergency room students, in comparison with their peers at other sites, averaged more patient contact, more direct observation, and more supervisory experiences.