Trends in patient encounters: implications for family medicine clerkships.

BACKGROUND AND OBJECTIVES: Adequate and equivalent clinical experience is related to the number and diagnoses of patients encountered and should provide students with experiences similar to community practice. This study compares the distribution of diagnoses family medicine clerkship students encountered at a Midwest medical school during 2009-2011 with both 1997-1999 data and the 2010 National Ambulatory Medical Care Survey (NAMCS) samples of family physicians and all physicians. METHODS: Electronically submitted encounter data (2009-2011) were compared to logbook data (1997-1999) and to the 2010 NAMCS data listing primary diagnoses at office visits in the United States by major disease category. RESULTS: Of the 15 diagnoses with ≥150 encounters, seven increased and eight decreased between the two time periods. The relative percent ratio of clerkship diagnoses distribution to the NAMCS family physician distribution revealed that diagnoses ratios were ≤100% in eight categories (clerkship experiences

Medical students' experience with musculoskeletal diagnoses in a family medicine clerkship.

Many US medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses the students experience. This study examines patients encountered with musculoskeletal diagnoses using quantitative data collected by family practice clerkship students. Over a two-year period, 445 students completed 7,202 patient encounter forms for patients with a musculoskeletal diagnosis, noting their confidence level and responsibilities. Of the 78,854 diagnoses presented, 7,850 were for musculoskeletal conditions. Students reported a lower level of confidence in diagnosing and treating musculoskeletal patients when compared with their confidence level in dealing with non-musculoskeletal patients. They are generally more actively involved with musculoskeletal patients by observing, seeing the patient before the preceptor, taking a history, suggesting treatment and discussing the case with the preceptor. At the study school, this fact may reflect that formal curricular teaching in orthopedics occurs in the fourth year, after students have completed their family medicine clerkship. It is concluded that by using a relatively simple computerized database, areas of need for curricular change can be identified. Our study verifies that additional training is needed in the area of musculoskeletal diagnoses.

Students' experience with women's health care in a family medicine clerkship.

UNLABELLED: Clerkship encounter forms were used to assess the types of diagnoses seen, the level of activities performed (student responsibility), and self-reported competence (comfort level) in dealing with patients. INTRODUCTION: Many medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses encountered by the students. This study examines clerkship students' experience with women's health care diagnoses. METHODS: Over a 2-year period, 445 students completed 3320 patient encounter forms for patients with a women's health diagnosis, noting patient age, location of care (office, hospital, etc.), up to four presenting diagnoses, the degree to which the student was involved with selected activities (taking a history, performing a physical examination, observing only, etc.) and the degree of self-reported competence. RESULTS: Of the 78 854 diagnoses presented, 3677 (6.1%) were women's health conditions, most commonly normal pregnancy (47.5%), disorders of menstruation (8.2%), menopausal and postmenopausal disorders (7.4%), disorders of the breast (6.0%), pain in female genital organs (5.7%), and disease of the cervix, vagina and vulva (5.2%). Students reported a high level of competence in diagnosing and treating these patients. The students routinely discussed women's health cases with their preceptors. DISCUSSION: Students reported that they were 'unskilled' or 'marginally competent' with approximately 10% of the women's health patient encounters, compared with 6% for all other encounters. The clerkship provided students with the greatest opportunity to observe and discuss individual cases with a preceptor. However, students infrequently suggested a treatment or provided patient education or women's health counselling.