Internal Medicine Clinical Teaching Unit: Is it an Inappropriate Site for Student Learning?

Abstract

Background: Internal medicine clinical clerkships usually emphasize student learning of hypothesis generation, problem solving, and patient management. At our school we are concerned that clinical teaching unit (CTU)-based patient exposure is not fostering development of these skills.

Purposes: We evaluated our clerks' interactions with patients on our CTUs to document whether the timing of student exposure to patients is conducive to the acquisition of basic clinical skills.

Methods: Once per week for 8 weeks, we met with all internal medicine clerks on the CTUs at our 4 teaching hospitals. Each student completed a questionnaire related to each patient worked up in the previous week. We specifically documented when the first interaction occurred with each patient. We also asked students for their perceptions of the learning experiences.

Results: Clinical clerks usually first interact with their patients after initial data acquisition, hypothesis generation, and ordering of investigations and therapy have been completed by other physicians. Students perceive that meeting patients late in the hospitalization is educationally disadvantageous.

Conclusions: Our clinical clerks usually interact with their patients late in the hospitalization and are therefore deprived of the opportunity to develop the key clinical skills of hypothesis generation, problem-solving, and investigation and management of patients.