Journal Club

Kalet A, Hopkins MA, Riles T. A rapid clerkship redesign to address new realities. Medical Education, Volume 38, Issue 11, Page 1193-1194, November 2004.

Reviewed by Linda Tewksbury, New York University

This article briefly outlines the process used by a surgery clerkship at NYU School of Medicine to undergo a rapid redesign through a systematic assessment of needs, implementation, and evaluation. Driven by a school mandate to reduce the length of the clerkship (from 10 to 8 weeks) and the recognition of dissatisfaction by both students and faculty with the "traditional clerkship model," the group used both qualitative (focus groups, surveys, in-depth interviews) and quantitative (test scores) assessment tools for pre/post evaluation of the new curriculum. Specific flaws in the curriculum (i.e. unclear structure, poorly defined core clinical content) were addressed by creation of clearly defined objectives and expectations for the students and teachers. Additional teaching models were introduced including newly designed asynchronous web-based multimedia learning modules (replacing lectures) and skill lab sessions. The curriculum was expanded to include communication skills and ethics. Criteria for evaluation were clearly defined and disseminated. Faculty and residents were evaluated on their teaching by students and given personalized feedback as well as opportunities for faculty/resident development.

Post-evaluation results included improved satisfaction and attitude of both faculty and students, no change in knowledge test scores, and an increase in student interest in pursuing general surgery as a career. Although details were not provided in this brief report, it is a good example of how positive change in a curriculum can be rapidly implemented through a systematic approach that includes qualitative and quantitative methods for assessing needs and evaluating results.

(Improving our clerkships always seems like a daunting task. These authors use solid educational methods to introduce change. All too often, an urgency to change results in a more haphazard approach. Looking at some of the other articles we reviewed in this edition of the Educator, perhaps we could use the systematic approach delineated here to help us incorporate a few innovations. Do you have a group of people who could help you complete a needs assessment? Identify gaps? Create and introduce new activities that are linked to measurable outcomes? Do you have any successes that you would like to share? Karen Marcdante)