Does early clinical practice in community settings change the perception and performance of students on preventive skills?

Dear Sir

Early clinical experience (ECE) in community settings helps medical students to understand the context in which they study, improves their motivation (Dornan et al. 2006). We aimed to investigate if ECE in the community changes the perception and performance of our students. Methodology was developed in the research in education course in the University of Maastricht. We used the data from the clinical skills of sampling of drinking water, chlorination, measurement of chloride. Each student was asked to complete an evaluation form of 10 questions using a Likert-type scale (1–5) and an overall evaluation question. Students had exams by two observers using checklists with pass/fail rating, given up to six chances to pass. In 2004, 150 students had courses in laboratory, in 2005 169 had them in the field. The difference of the means for the 2 years were examined by independent samples t-test and Bonferroni corrected significance was calculated. We also compared the percentages of the students passed in first and second chances with chi-square.

Total 136 (90.7%) completed the forms in 2004, 138 (81.7%) in 2005. The field group (2005) had higher scores. The differences in two scores “I think that skill is necessary (p < 0.01)” and “I can apply that skill in my professional life (p < 0.02)” were statistically significant as were the overall evaluation scores (p = 0.047). The corresponding effect sizes were 0.82 and 0.37, which are considered large and medium effects, respectively. However, the difference in the performance rates was not statistically significant, 122 (81.3%) passed in their first/second chance in 2004, 143 (84.6%) in 2005. As a conclusion, we found a positive impact of ECE in the community on the perceptions of the students regarding preventive skills. We could not find any significant impact on the performance.