Council on Medical Student Education in Pediatrics


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The long and short of it. Hauer K et al. More is better: Students describe successful and unsuccessful experiences with teachers differently in brief and longitudinal relationships. Academic Medicine 2012;87(10):1--8.

Reviewed by: Rebecca Tenney--Soeiro

What was the study question?
How do students' successful and unsuccessful teaching experiences in brief and longitudinal relationships differ?

How was the study done?
Students at three US medical schools that have both block and longitudinal clerkships (University of California San Francisco, University of South Dakota Sanford, and Harvard) were recruited to be interviewed at the beginning and end of their clerkship year. Questions were designed to elicit descriptions of successful and unsuccessful relationships with teachers. Follow--up questions focused on successful teachers' approaches to teaching and feedback, and the relationship between unsuccessful teachers and their students. Transcripts were coded and thematically analyzed.

What were the results?
Three themes most differentiated brief (block) and longitudinal relationships: time, purpose, and power. Time: Students in block rotations characterized "continuity" as 2--4 sessions over days to a few weeks while longitudinal students discussed their collaborative contact over an entire year. Purpose: Brief students frequently commented on "pimping" as a way teachers assessed their knowledge while longitudinal students discussed iterative and collaborative discussions with their teachers. Power: Hierarchy dominated block relationships while longitudinal students experienced a "developmental transfer of responsibility."

Unsuccessful relationships were rarely resolved in block relationships, and common strategies used by students were to wait for the rotation to end or try harder to perform well and match teachers' preferences. In contrast, longitudinal students expressed more commitment to talk with preceptors to understand problems, brainstorm solutions, and find a resolution.

What are the implications of these findings?
Students in both situations valued teachers' interest, clearly articulated expectations, and guidance. In brief relationships students focus on explicit knowledge. In longitudinal relationships students gain insight of workplace cultures and teamwork in applying knowledge to patient care.

Editor's note: Originating in Minnesota about 40 years ago, and then followed in Flinders, Australia and Norway many years later, longitudinal clerkships now occur in many countries. This study reminds us of the qualities of exceptional teachers and challenges us to figure out ways to be as collaborative, supportive, and invested as the teachers in the longitudinal clerkships, even if we teach in a block rotation. This study also highlights how students yearn to be included, to be recognized and remembered, to be treated with interest. Students remarked that they were "surprised and satisfied that attendings acknowledged them in hospital or used their names." How unfortunate that the bar for our performance is so very low (SLB).

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