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Do Clerkship Directors Think Medical Students Are Prepared for the Clerkship Years? Donna M. Windish, Paul M. Paulman, Allan H. Goroll, and Eric B. Bass Academic Med 2004. 79(1): 56-61. Reviewed by Sherilyn Smith, University of Washington


Do Clerkship Directors Think Medical Students Are Prepared for the Clerkship Years?

Donna M. Windish, Paul M. Paulman, Allan H. Goroll, and Eric B. Bass Academic Med 2004. 79(1): 56-61.

Reviewed by Sherilyn Smith, University of Washington

Background: The purpose of current study was to assess clerkship directors' perceptions of student preparedness in the area of six core competencies, similar to those described by the ACGME for residency training. The core competencies outlined in this study were: communication skills, interviewing/physical examination, professionalism, clinical epidemiology and probabilistic thinking, understanding systems of care and understanding a patient's life-cycle stage.

Methods: A survey was sent to a randomly selected subset of clerkship directors in the fields of pediatrics, internal medicine, family medicine, obstetrics/gynecology, surgery and psychiatry. Demographic data about the clerkship directors and the respondent schools were collected. Directors were asked to rate the level of ability (none, minimal, intermediate, advanced) in each of 6 areas that students should have when BEGINNING clerkships. Directors were also asked to estimate how prepared they felt their students were (much less prepared than necessary, less prepared than necessary, at the level they should be, more prepared than necessary, much more prepared than necessary) in these 6 areas.

Results: Thirty-two schools were selected and the survey response rate was 74%. Schools in the West/Southwest and surgery clerkship directors were less likely to respond. Clerkship directors supported the notion that the articulated competencies were "core" and most frequently cited interviewing/physical examination (32%) and communication skills (21%)as important. Their views on the level of skill in each of the competencies and the degree of student preparedness is outlined below:

Directors Perception

Communication

Interview/PE

Professionalism Epi/Reasoning Healthcare systems Life Cycle Stages
Interm/advanced skill neded 95% 80% 95% 60% 30% 55%
Less prepared than needed 30% 45% 30% 50% 40% 30%

There was little variability in responses according to specialty or years teaching. Those with more experience teaching in the pre-clinical years felt students needed intermediate/advanced skills and were less well prepared in the area of interviewing/PE. Those with a higher percentage of time in the outpatient setting were more likely to report that students were less prepared than necessary in epidemiology/probabilistic reasoning.

Comments: This is an interesting study that begins to address what skills should be taught throughout the 4 years of undergraduate medical training. There was consensus about the content (98% of respondents agreed with the 6 core competencies). A high proportion of the respondents felt that students should have advanced skills in 3 of the 6 competencies and that a significant portion of our students are not adequately prepared in these areas. Students may need less advanced skills in the other areas but their preparedness is still inadequate. What is missing from this article is a better description of the competencies. I am unsure what knowledge/skills/attitudes students should have in communication skills or life-cycle stages. I also wonder what "intermediate or advanced skills" means and what the level of preparedness means. Inclusion of these definitions would make the generalizability of the article clearer. The next steps then might be developing specific curricula, benchmarks and expectations/evaluation materials for these areas in a developmentally appropriate manner. Perhaps, if students are appropriately prepared in these "core competency" areas, they may be better able to assimilate new knowledge and skills during their clinical rotations (although this hypothesis needs to be tested!)

(The underlying rationale for this study, was to generate an imperative to enhance medical student preparedness for the major clerkships. Do you believe that medical students at your school are adequately prepared for the major clinical clerkships when they begin their major clinical year? Would you advocate for more clinical training prior to starting the major clerkships at your school? Steve Miller)

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