Evaluation of a clinical attachment in Primary Health Care as a component of undergraduate medical education

Figures & data

Table

Practice points

Clinical attachments in PHC have already proven their effectiveness in countries with a well–established system of undergraduate medical education in general practice/PHC. Despite the lack of experience in such projects, the two-year experience of introducing a clinical attachment in a PHC unit in the curriculum of a medical school of a country that literally lacks any kind of PHC–oriented medical education helped the students improve their clinical skills. The contact of medical students for the first and only time with PHC during this attachment may have influenced them in terms of selecting general practice as a career choice after their graduation.

Table 1.  Basic characteristics of medical students participating to the general practice clinical attachment

Variable	Men (N = 246)	Women (N = 267)	Total (N = 513)	p-value
Age	20.07 ± 1.12	19.98 ± 1.14	20.02 ± 1.13	0.368
Area of origin
Urban	119 (48.37)	134 (50.19)	273 (53.22)	0.427
Semi-rural	59 (23.98)	72 (26.97)	127 (24.76)
Rural	68 (27.64)	61 (22.85)	113 (22.03)
Knowledge of at least one foreign language (CEFR* level: C2)	29 (11.79)	33 (12.35)	62 (12.09)	0.843
Having at least one parent medical doctor	85 (25.68)	82 (23.50)	167 (24.56)	0.508
Having awarded at least one academic distinction	17 (6.91)	19 (7.12)	36 (7.02)	0.927
Having other academic degree	7 (2.85)	6 (2.25)	15 (2.53)	0.667

*Common European Framework of Reference for Languages: Learning, Teaching, Assessment.

Table 2.  Mean scores on objective structured clinical examination of participants before and after the clinical attachment

Skill	Before	After	p-value
History taking (maximum score 30)	11.28 ± 5.41	18.53 ± 4.34	<0.001
Physical examination (maximum score 30)	5.74 ± 1.89	16.83 ± 2.51	<0.001
Ability to interpret basic medical data (maximum score 30)	7.42 ± 3.63	19.01 ± 5.68	<0.001
Communication skills (maximum score 10)	6.26 ± 2.63	7.91 ± 1.84	<0.001
Total score (maximum score 100)	30.70 ± 3.24	62.28 ± 3.97	<0.001

Table 3.  Probability of selection of general practice as a career choice before and after attachment

	Men (N = 246)		Women (N = 267)		Total (N = 513)
	Before attachment	After attachment	Before attachment	After attachment	Before attachment	After attachment
Likely/Very likely	31 (12.60)	53 (21.54)	25 (9.36)	43 (16.10)	56 (10.92)	96 (18.71)
Neutral	74 (30.08)	55 (22.36)	82 (30.71)	54 (20.22)	156 (30.41)	109 (21.25)
UnlikelyVery unlikely	141 (57.32)	138 (49.46)	160 (59.93)	170 (63.67)	301 (58.67)	308 (60.04)
p-value	0.014		0.004		<0.001

Table 4.  Student's ratings and achievement of learning goals and expectations

Variable (maximum score 5)	Mean ± SD
Ratings of preceptors
Was experienced in his subject	4.13 ± 0.52
Was able to clearly respond to questions	4.24 ± 0.56
Showed patience	3.97 ± 0.84
Was enthusiast for his subject	4.53 ± 0.45
Gave opportunity to actively participate	4.33 ± 0.41
Was friendly	4.70 ± 0.28
Informed us about general practice	4.45 ± 0.33
Overall rating	4.51 ± 0.29
Own impressions
Achievement of learning goals	4.32 ± 0.54
Achievement of own expectations	4.15 ± 0.49
Overall impression of the attachment	4.39 ± 0.42