Clinical experience of medical students in primary care: use of an electronic log in monitoring experience and in guiding education in the Cambridge Community Based Clinical Course.

OBJECTIVES: The amount of medical student teaching in the community has increased markedly recently, but uncertainties remain about whether there is sufficient clinical material to meet students' learning needs and, if so, how best to monitor the experience and ensure that students are benefiting from it. DESIGN: On the Cambridge Community Based Clinical Course, a 15-month attachment in primary care, the students used hand-held computers to monitor their clinical experience as it developed. SETTING: The General Practice and Primary Care Research Unit, Cambridge, UK. SUBJECTS: Medical students. RESULTS: Thirteen students recorded 8140 contacts over 4 years. Contacts recorded by students over 15 months varied between 256 and 1153. Eight specialities each contributed more than 5% of total experience. These were general medicine, 26.9% (range 23.8%-36. 6%), obstetrics and gynaecology, 11.3% (range 7.2%-17.1%), orthopaedics and rheumatology, 11.3% (range 3.7%-15.2%), paediatrics, 10.7% (range 4.1%-19.8%), ENT, 7.4% (range 3.3%-10.2%), dermatology, 7.1% (range 4%-10.1%), psychiatry, 6.4% (range 5%-9.7%) and general surgery, 6.4% (range 1.1%-9.9%). CONCLUSIONS: The results show that it is possible to get a broad and varied exposure to clinical problems on a long-term community-based course. However, as a consequence of the opportunistic way in which clinical experience is obtained on a community attachment, individual students often had gaps in their experience. The logs provided a means for identifying these gaps so that action could be taken to address them. The logs themselves proved to be a practical and feasible way to record student experience as it unfolded.

Teaching clinical methods to medical students.

This paper demonstrates that it is feasible to teach clinical methods in general practice and describes the organization of an appropriate attachment. Willing practitioners, properly briefed, are competent to undertake clinical methods teaching and the attachment provides satisfaction to both students and teachers. It is possible to provide in primary care the elements which seem to be the key to this outcome--protected time, teaching in very small groups, direct observation and concentration on systematic examination rather than on particular physical signs. There is a strong case for the promoting of clinical methods teaching by general practitioners.

Assessing release courses in vocational training.

A series of visits to selected vocational training schemes revealed a wide variation in attendance by trainees, content of release courses, use of teaching methods, and participation in planning by trainees. The principal criticism made by ex-trainees was the absence of enough teaching on practice management.I suggest that it is important to clarify as soon as possible the division of teaching responsibilities between training practices and release courses.