Effectiveness of standardized clerkship teaching across multiple sites.

BACKGROUND: Surgical clerkship teaching for medical students at the University of Auckland is undertaken across multiple clinical campuses. Concerns are that differences in clinical experience may result in variability of learning outcome achievements. Our objectives were to investigate whether differences in clinical experience existed between teaching sites, and whether these differences correlate to differences in learning outcome achievements. Influence of clinical experience on future career choice was also explored. MATERIALS AND METHODS: Prospectively collected data were retrospectively reviewed. Clinical experience from assigned hospitals was collected using student Feedback Questionnaires and case history logbooks. Results were analyzed for inter-hospital differences. The Questionnaire included a question on influence of clinical experience on future career choice. A formative Objective Structured Clinical Examination (OSCE) was administered and results were analyzed for inter-hospital differences in learning outcome achievements. RESULTS: Feedback Questionnaires and case history logbooks identified inter-hospital differences in clinical experience. Clerkship enjoyment and involvement in theater correlated with increased likelihood of choosing a future surgical career. The OSCE had acceptable internal reliability (Cronbach's α 0.69-0.74) and strong correlations with other formal assessments, indicating its external validity. No significant inter-hospital differences in OSCE results were found after one-way analysis of variance comparison (P=0.125). CONCLUSION: Heterogeneity of clinical experience from multiple teaching sites did not translate into heterogeneity in achievement of learning outcomes when teaching and assessment materials were standardized. Clinical experience during undergraduate clerkships may influence future career choices. The OSCE is a validated and reliable tool for assessing student achievement of learning outcomes.

A survey of general surgery clerkships in Australian and New Zealand medical schools.

BACKGROUND: Surgical clerkships facilitate development of knowledge and competency, but their structure and content vary. Establishment of new medical schools and raising student numbers are new challenges to the provision of standardized surgical teaching across Australasian medical schools. A survey was conducted to investigate how Australian and New Zealand medical schools structure their general surgery clerkships. METHODS: Between April and August 2009, a 30-item web-based survey was electronically sent to academic and administrative staff members of 22 Australian and New Zealand medical schools. RESULTS: Eighteen surveys were returned by 16 medical schools, summarizing 20 clerkships. Ten schools utilize five or more different clinical teaching sites for general surgery clerkships and these include urban and rural hospitals from both public and private health sectors. Student teaching and assessment methods are similar between clerkships and standardized across clinical sites during 10 and 16 of the clerkships, respectively. Only eight of the surveyed clerkships use centralized assessments to evaluate student learning outcomes across different clinical sites. Four clerkships do not routinely use direct observational student assessments. CONCLUSIONS: Australian and New Zealand medical schools commonly assign students to multiple diverse clinical sites during general surgery clerkships and they vary in their approaches to standardizing curriculum delivery and student assessment across these sites. Differences in student learning are likely to exist and deficiencies in clinical ability may go undetected. This should be a focus for future improvement.