A New Clinical Skills Clerkship for Medical Students

摘要

Background and Objectives: The transition to clinical clerkships can be challenging for medical students. In the context of a formal clinical curriculum redesign, a curriculum team led by family physicians systematically planned and implemented a 3-week course to prepare new third-year students for specialty-specific clerkships.Methods: Informed by a formal needs assessment, we developed a classroom-based Clinical Skills Clerkship (CSC) with varied instructional approaches. The three major curriculum components are (1) specialty-specific, longitudinal clinical care of a three-generation virtual family that is taught in lectures and small groups and assessed with an objective structured clinical examination (OSCE), (2) clinical skills including procedure stations and interprofessional education experiences, and (3) a series of professional development activities. The CSC has 90 hours of curriculum taught by more than 120 faculty members from a wide variety of specialties and disciplines. A cohort of senior medical students teach in the course as part of a medical education elective.Results: The CSC was first delivered to 98 students in 2012 who performed well on the course’s OSCE. Quantitative and qualitative evaluations of both the curriculum components and the senior medical student teachers were positive. Performance on comparable CSC and Internal Medicine Clerkship OSCE stations and a series of student focus groups demonstrate longer-term impact.Conclusions: A successful curriculum redesign requires considerable planning and coordination. We designed and implemented a comprehensive CSC that was both well received and effective. Peer teaching programs can provide medical education leadership experiences with benefits for learners, teachers, and medical educators.(Fam Med 2014;46(6):433-9.)The transition from the pre-clinical to the clinical years of training is invariably anxiety provoking for medical students. Sources of the anxiety include understanding new roles, responsibilities, and expectations; adjusting to teams and clinical settings; adapting to new schedules and workloads; integrating preclinical knowledge into the clinical setting; and performing clinical skills.1-4 Clerkship directors often find medical students ill-equipped to begin their clinical experiences;5 specifically, they under-appreciate the impact of cultural differences among specialties.1Historically, this transitional challenge has been addressed through the addition of problem-based learning modules and discrete clinical skills courses in Years 1 and 2 and longitudinal clinical skills courses in Year 3.2,5-7 An alternative but not mutually exclusive strategy to systematically link the pre-clerkship experiences to the clinical experiences is to develop a dedicated transition course that students complete immediately before starting clerkships.8-9While many US medical schools have adopted transition courses, they vary widely in terms of length (from days to weeks), content, and instructional approach.10-12 Poncelet and O’Brien suggest that an effective transition course should (1) address those weaknesses or sources of transitional struggle as identified by both students and faculty, (2) develop specific objectives that are able to be evaluated, and (3) ensure that instructional approaches meet those needs and objectives.10,13 Here, we describe the systematic development and implementation of a central component of the Doctoring program, which is our institution’s comprehensive, 4-year clinical skills curriculum:14 a novel 3-week Clinical Skills Clerkship (CSC) for rising third-year medical students.Methods