Length of Attending-Student and Resident-Student Interactions in the Inpatient Medicine Clerkship

Abstract

Phenomenon: Changes in the medical education milieu have led away from the apprenticeship model resulting in shorter physician–student interactions. Faculty and student feedback suggests that supervisor/student interactions may now be more cursory with increasing numbers of supervisors per student, and shorter duration of interaction. This may affect both education and student assessment. Approach: We compared inpatient attending and resident daily schedules with those of 3rd- and 4th-year medical students rotating on medicine clerkships at Brigham and Women's Hospital during academic years 2009–11 to determine the number of days of overlap. We used evaluation forms to determine the extent of evaluator's self-reported knowledge of the student. Findings: We correlated the daily schedules of 199 students and 204 resident and 187 attending physicians, which resulted in 558 resident–student pairings and 680 attending–student pairings over 2 years. During a 4-week block, students averaged 3.7 attending physicians (M = 4, range = 2–7), with 49.7% supervised by 4 or more. Attending-student overlap averaged 9 days (M = 9, range = 2–23), though 40% were 7 days or less. Students overlapped with an average 3.4 residents (M = 3, range = 1–6). Resident-student overlap averaged 12 days (M = 11, range = 3–26). There were 824 student assessment forms analyzed. Resident and attending physician supervisors describing knowledge of their student as “good/average” overlapped with students for 14 and 11 days respectively compared to resident and physician supervisors who described their knowledge as “poor” (11 days, p < .01; 6 days, p < .01). Insights: On the inpatient medicine clerkship, students have multiple supervising physicians with wide variability in the period of overlap. This leads to a disrupted apprenticeship model with fragmentation of supervision and concomitant effects on assessment, feedback, role modeling, and clerkship education.

Keywords:

• medical school
• clerkship
• team structure
• evaluation
• interaction
• apprenticeship

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