Perceived educational value and enjoyment of a rural clinical rotation for medical students.

INTRODUCTION: It is well-recognised that medical students whose training exposure is largely limited to tertiary-level training hospitals may be inappropriately equipped to deal with the most relevant health issues affecting rural communities. This article evaluated the perceived educational value of a 2 week clinical rotation undertaken by senior undergraduate medical students at rural district hospitals and health care centers in the Western Cape Province, South Africa. METHODS: Students completed a daily log diary to provide an overview of time spent on specific academic activities, ranking the educational and enjoyment value of each activity. At the end of the 2 week rotation students completed an open-ended questionnaire capturing the main positive and negative aspects of their experience, followed by focus group discussions with a randomly selected subgroup. In addition, a formal feedback seminar was arranged with the academic supervisors at each of the training sites to triangulate the information received and to document their perspective. RESULTS: Thirty-seven students consented to study participation and 25 (68%) adequately completed the log diaries and questionnaires, rating the following activities as most educational: 'assisting in theatre', 'teaching by doctor', 'seeing patients in clinic/health centre/OPD' and 'mobile clinic excursions'. The rural experience allowed practical application of their theoretical knowledge, which improved their levels of confidence and enjoyment. The most enjoyed activities were: 'mobile clinic excursions', 'performing medical procedures' and 'teaching by doctor'. The students were critical of some aspects: (i) the rural rotation was not structured efficiently; (ii) compulsory written reports and additional projects prevented them from maximizing the rural experience; and (iii) a time period of 2 weeks was felt to be too short for optimum benefit from the rotation. CONCLUSION: The feedback obtained from this log diary study demonstrates that well-functioning rural health care centers provide excellent opportunities for students to develop the most relevant practical skills required of generalist doctors working in resource-limited settings. In addition to a more efficiently structured rural program, students requested an increase in the length of the rotation and a reduction in the written academic workload.

What do students actually do on an internal medicine clerkship? A log diary study.

BACKGROUND: There are limited data on the amount of time students spend on teaching and learning while on internal medicine clerkships, and existing data suggest a wide international variation. Community-based teaching of internal medicine is now widespread; but its strengths and weaknesses compared to traditional hospital based teaching are still unclear. AIM: To determine the proportion of time students spend on different activities on an internal medicine clerkship, and to determine whether this differs in general practice and in hospital. In addition we aimed to determine students' views on the educational value and enjoyment of various activities. METHODS: Prospective completion of log diaries recording student activities. Each student was asked to complete the diary for two separate weeks of their internal medicine clerkship: one week of general practice-based teaching and one week of hospital-based teaching. RESULTS: The response rate was 68% (88/130). Students spent approximately 5.5 h per day on teaching and learning activities in both environments, with more time (50 min vs. 30 min, P = 0.007) on unsupervised interaction with patients in hospital than in general practice, and more time (53 min vs. 21 min, P < 0.001) undergoingassessment in general practice than in hospital. Standard deviations were wide, demonstrating the heterogeneous nature of the data. Students perceived supervised interaction with patients and teaching by doctors as the most educational activities in both environments, but found it even more educationally valuable and enjoyable in general practice than in hospital (mean score for educational value: 4.27 in general practice, 3.88 in hospital, P = 0.048; mean score for enjoyment 4.13 in general practice, 3.66 in hospital, P = 0.03). CONCLUSIONS: Students greatly value interactions with patients, perceiving these as both educational and enjoyable. Curriculum planners must continue to place patient-based learning at the centre of undergraduate medical education. The heterogeneity of the data suggests that individual students have very different experiences, despite apparently similar timetables.

Do we teach what we preach? Comparing the content of a problem-based medical curriculum with primary health care data.

The content of a problem-based medical curriculum has been analysed with reference to educational and medical characteristics. The data have been compared with primary health care data obtained from the Registration Network Family Practices, a computerized health information system in the southern part of the Netherlands. The analysis reveals differences between curriculum and health care data on several aspects such as reasons for encounter/complaints, problems/diagnoses, chronic diseases, health problems of children and referrals to specialists. Although the analysed material reflects only part of the curriculum, it can be concluded that the primary care orientation of the curriculum is meagre and that a critical review of the patient cases used in the problem-based curriculum is needed.

The University of Limburg family practice preceptorship programme.

A six-year experience with a required preceptorship programme for fifth-year students in the Netherlands is described. After one week of introduction students spend 11 weeks with a family physician. Students prepare records of their independent contact with a patient, which are discussed with their preceptors and their faculty tutor. Analysis of the records revealed that students see a fair sample of problems presented in primary care. The programme is well accepted by students and preceptors. The importance of good relations between the school and the preceptors is stressed.