Understanding Clerkship Student Roles in the Context of 21st-Century Healthcare Systems and Curricular Reform

ABSTRACT

Phenomenon: Preclerkship medical education has undergone extensive reform, and the clerkship years are growing targets for curricular innovation. As institutions implement new preclerkship curricula to better prepare medical students to practice medicine in the context of modern healthcare systems, the perspective of clerkship leaders regarding clerkship student roles and potential for change will facilitate redefining these roles so that preclerkship educational innovations can continue into clerkships. Approach: In this qualitative exploratory study, authors conducted semistructured interviews with clerkship and site directors for eight core clerkships from April to May 2016. Questions addressed how clerkship leaders perceive current student roles and the potential for change. Through iterative consensus building, authors identified themes describing current ideal clerkship student roles applicable to future roles. Findings: Twenty-three of 24 (96%) directors participated. Findings fell into four themes: factors influencing the clerkship role, clerkship student role archetypes, workplace authenticity and value, and potential for change. Student, supervisor, and context factors determine the clerkship student role. Three role archetypes emerged: the apprentice (an assistant completing concrete patient care tasks), the academic (a researcher bringing literature back to the team), and the communicator (an interdisciplinary and patient liaison). Each archetype was considered authentic and valuable. Positive attitudes toward preclerkship curricular changes were associated with openness to evolution of the clerkship students' role. These emerging roles mapped to the archetypes. Insights: Clerkship leaders perceive that student, supervisor, and context factors result in varying emphasis on role archetypes, which in turn lead to different types of learning. Medical educators can use the archetypes to articulate how expanded student roles align learning with clinical needs, particularly as they relate to health systems science and inquiry.

KEYWORDS:

• clerkship education
• undergraduate medical education
• workplace learning
• curricular reform
• qualitative research

Acknowledgments

We thank Dr. Patricia Cornett and Dr. Gordon Strewler for their support in the initial conceptualization of this study.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

Ethical approval

This study was approved by the Institutional Review Board at the University of California, San Francisco.

Previous presentations

Preliminary results of this study were presented as an oral presentation at the Association of American Medical Colleges Western Group on Educational Affairs meeting in Salt Lake City, Utah, February 2017, and poster presentation at the Society of General Internal Medicine meeting in Washington, DC, May 2017.