Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students

Figures & data

Table 1. Results of the clerkship preparedness survey.

		N	Mean	Std. deviation	p-Value*	Effect size**
History taking (I know how to gather useful clinical information from a new patient in a reasonable period of time)	Participants	20	4.2	0.5	.012	.905
	Waitlisted	22	3.7	0.6
Physical exam (I am able to detect most major abnormalities that my residents/attendings find)	Participants	20	3.7	0.7	.004	.992
	Waitlisted	22	2.9	0.9
Oral case presentation (I know what information to include when presenting a new patient to my attending)	Participant	20	3.8	0.8	.006	.936
	Waitlisted	22	2.9	1.1
Assessment/plan (I know how to formulate a problem-based assessment/plan for a hospitalized patient)	Participant	20	3.5	0.8	.001	1.104
	Waitlisted	22	2.5	1.0
Stress/Well-being (I feel overwhelmed and/or very anxious about how to succeed in clerkships)	Participant	20	2.8	1.1	.052	.636
	Waitlisted	22	3.5	1.1
Confidence in my abilities (While I still have a lot to learn, I feel confident that my abilities in patient care are at the right level for my stage in training)	Participant	20	3.8	0.8	.036	.705
	Waitlisted	22	3.2	0.9
***Composite: Professionalism items (combines six items, described in legend)	Participant	20	4.0	0.4	.028	.702
	Waitlisted	22	3.6	0.7

Respondents rated agreement with each item on a five-point Likert scale from Strongly disagree [1] to Strongly agree [5].

*p-Value:  With Bonferroni correction for multiple comparisons, significance is reached at 0.05/7 = 0.007.

**Effect size: Given similar standard deviations between our groups, effect size measured using Cohen’s d.

***‘Professionalism’ combined responses to six items on self-efficacy/attitudes about self-assessment, seeking out feedback, creating an individualized learning plan (ILP), and creating strategies for meeting learning goals.

Table 2. Thematic analysis with representative quotes to open-ended questions in the Clerkship Preparedness Survey.

Theme	Representative Quotations
Learning how to construct an Assessment and Plan (A&P)	The practice of developing an A&P was valuable as it is not a skill we practice often when presenting during the first two years. The elective was the first time I had done a formal assessment and plan, and I’m glad I was able to practice a few times before third year started.
Practice with oral presentations	Simply forcing the student to sit down and write out a note and orally presenting it was enormously helpful in exposing weak points. It wasn’t until I was expected to come up with a full note and then present it formally that I realized how unwieldy and foreign many aspects of either task were for me. Practicing…and then receiving extensive feedback about all aspects of [the oral presentation] was incredibly valuable immediately before heading out onto the wards.
Individualized attention and feedback from an invested attending	Provided individualized attention from attendings and longitudinal assessment of goals identified in our ILP. Attendings were great about being familiar with my specific goals and discussing progress, as well as remaining weaknesses. One-on-one teaching with faculty and dedicated time [for] feedback
Practice with history-taking	Practice in taking a full history from a new patient. History taking with pertinent positives and negatives. Being able to interview…real patients

Representative elective student responses to: (1) In what ways did the elective course ‘Hospital-Based Medicine: A Clinical Skills Tutorial’ help to prepare you for clerkships? and (2) What was the most useful aspect of the course ‘Hospital-Based Medicine: A Clinical Skills Tutorial?’ grouped by the most commonly mentioned themes.

Table

Competency domains	Challenge
Patient care
Medical knowledge
Practice-based learning & improvement
Interpersonal & communication skills
Professionalism
Systems-based practice

Cooke M, Irby DM, O’Brien BC. Educating physicians: a call for reform of medical school and residency. San Francisco (CA): Jossey-Bass; 2010.

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O’Brien B, Cooke M, Irby DM. Perceptions and attributions of third-year student struggles in clerkships: do students and clerkship directors agree? Acad Med. 2007 Oct;82(10):970–978.

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