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The Clerkship Pediatric Rotation: Does setting matter? Bollegala, N et al. Canadian Med Ed Journal 2010, 1(1)


Submitted by: Sarah Gander, MD, FRCPC St John, New Brunswick

What was the study question?
The study question was to explore if by completing your pediatric clerkship in a community rotation versus an academic centre, your clinical performance, examination performance, written assignment performance and/or successful matching to CaRMS (Canadian Residency Matching service) was affected.

How was the study done?
The 340 medical students from the 2007 and 2008 graduating classes from the Hospital for Sick Children in Toronto, were allowed to choose their preferred site for their pediatric experience: a full six weeks in the community (168 students) or a three week community, three week academic centre spilt (172 students). They looked at the differences between the groups and the differences with all the variables (clinical, examinations, assignments and the CaRMS match). Standard statistical methods were used.

What were the results?
Students in the community rotations scored higher on clinical evaluations (p<0.01) but not on examination marks or written assignments. The numbers were too small for the match to a Pediatric residency though CARMS to draw any conclusions, but 10 matched from the academic centre rotation group and 4 from the community setting. It was noted that there is a selection bias for the academic centre rotation if the student expressed pre-clerkship interest in paediatrics. If the student had an interest in paediatrics, they also performed better on all evaluations.

What are the implications of these findings?
This study illustrated that the outcomes are very similar whether medical students choose purely community based clerkship experiences or one with time in an academic centre. Presumably their clinical experiences and exposures, while not necessarily equivalent, are comparable. What was interesting was that medical students interested in paediatrics usually choose the academic site. Perhaps they are looking to be close to the residency program or networking with staff in order to enhance the likelihood of their acceptance. Interestingly, at least in other centres in Canada, often the community physicians are very involved in the tertiary centres administrative and residency programs. If only they knew.

(Editor's note: This article comes from the inaugural edition of the Canadian Medical Education Journal, an on-line peer-reviewed journal. Like previous articles on this topic, the results show that students did equally well on examinations whether they did their pediatrics rotation in a community or academic site. As medical school classes increase and alternate sites to academic health centres are explored for training and subsequently used for education, these results are reassuring.)

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