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Groundwork

Navigating Tensions of Efficiency and Caring in Clerkship: A Qualitative Study

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Pages 378-384 | Published online: 31 Dec 2018
 

Abstract

Phenomenon: Clerkship is a challenging transition during which medical students must learn to navigate the responsibilities of medical school and clinical medicine. We explored how clerks understand their roles as both medical learners and developing professionals and some of the tensionss that arise therein. Understanding how the clinical learning environment shapes the clerkship role can help educators foster compassionate care. Approach: We conducted 5 focus groups and 1 interview with 3rd-year medical students (n = 14) at University of Toronto between January and June 2016 regarding the perceived role of the clerk, compassionate care, assessment and feedback. Data were analyzed thematically. Findings: In addition to transitioning to a new learning environment, clerkship students assume different roles in response to complex and often competing expectations from preceptors. We identified three main themes: learning to impress preceptors with varying expectations, providing compassionate care—sometimes supported by preceptors, other times being secondary to efficiency—and passing assessments that required a different skill set than simply being a “good clerk.” Insights: Clerks perceive their role as providing compassionate care to patients and balance this with fulfilling the (sometimes) competing roles of being a student and developing medical professional. In a system where efficiency is often prioritized, medical students are afforded an opportunity to help satisfy the demand for greater compassion in patient-centered care.

Acknowledgments

Andrew Perella and Tal Milman are co-first authors; each contributed equally to the project and to the manuscript. We thank Victoria Boyd for her assistance with this project.

Funding/Support

This research was supported by the Associated Medical Services Phoenix Call to Caring Project Grant (Toronto, Ontario), Michael Garron Hospital and the Toronto East Health Network (Toronto, Ontario), the Department of Medicine at the University of Toronto, Faculty of Medicine (Toronto, Ontario), and the Center for Ambulatory Care Education at Women’s College Hospital (Toronto, Ontario).

Other disclosures

None

Ethical approval

This research was approved by the University of Toronto Research Ethics Board (Ref: 32140).

Disclaimers

None

Previous presentations

Portions of this research were presented in an oral presentation at the Canadian Conference on Medical Education 2017 in Winnipeg, Manitoba on May 1, 2017.

Additional information

Funding

This research was supported by the Associated Medical Services Phoenix Call to Caring Project Grant (Toronto, Ontario), Michael Garron Hospital and the Toronto East Health Network (Toronto, Ontario), the Department of Medicine at the University of Toronto, Faculty of Medicine (Toronto, Ontario), and the Center for Ambulatory Care Education at Women's College Hospital (Toronto, Ontario).

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