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Article Review: Expectations of medical student clinical skill

Posted Aug 09 2010 12:00am
Traditionally in U.S. medical schools, the first 2 years focus on book-learning and the last 2 years focus on clinical experience. This follows the Flexner model of medical training.

A growing trend in U.S. medical schools is the early integration of clinical experience into the first 2 years of medical school. Successful longitudinal integration depends on setting clear goals for basic clinical skills competency. Not much is known about what basic clinical skills medical students should have upon entering their traditional clinical clerkship rotations.

This survey-based study from the University of Washington assessed 3 populations:
  1. Third-year medical students, who have completed 3 months of clerkships
  2. Preclinical faculty who provide second-year medical students early clinical teaching and exposure
  3. Clerkship directors of required 6 clerkships (IM, FM, Surgery, Psych, Peds, Ob/Gyn)
Response rates ranged from average to excellent. Generally a survey response of >70% is reasonable.
  • Students: 62% (115 of 185)
  • Preclinical faculty: 91% (30 of 33)
  • Clerkship directors: 58% (56 of 97)
Outcome Measures
Skills assessed were divided into 3 categories. Each subject was asked to rank what level of preparation was expected for 3rd year students beginning their clinical clerkship. The rating scale ranged from 1 to 5 (1=none, 5= considerable preparation).

1. Basic Clinical Skills
  • Communication skill
  • Taking a comprehensive history
  • Complete review of systems
  • Performing a full physical exam
  • Comprehensive oral case presentation
  • Complete write-up
  • Working as a team member
  • Receiving feedback
2. Advanced Clinical Skills
  • Focused history
  • Focused physical exam
  • Focused oral presentation
  • Preparing SOAP notes
  • Clinical reasoning
  • Preparing assessment and plan
  • Differential diagnosis
3. Knowledge-Related
  • Basic science knowledge
Results
There were some interesting statistically-significant findings.
  • Preclinical faculty and students had higher expectations than clerkship directors when it came to most basic clinical skills preparation.
  • Students, as a whole, expected greater preparation for all of the 7 advanced clinical skills prior to starting clerkships.
  • Interestingly, clerkship directors had higher expectations for only 1 item when compared to preclinical faculty. That was in "preparing SOAP notes". I totally agree. Clinical students notoriously do not appreciate the importance of documentation.
Bottom Line
In the upcoming age of vertical integration of clinical experiences throughout medical school, there should be more open communications about expectations of the 3rd year clerkship student. This is similar to the concept of handing off patients from one provider to another for further care. In this case, preclinical faculty are "handing off" students to clerkship directors for further education. We need to make sure that both parties are on the same page.

Reference
Marjorie Wenrich1, Molly B. Jackson, Albert J. Scherpbier, Ineke H. Wolfhagen, Paul G. Ramsey, & Erika A. Goldstein (2010). Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships Medical Education Online, 15 : 10.3402/meo.v15i0.5295
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