Ready or not? Expectations of faculty and medical students for clinical skills preparation for clerkships

Abstract

BackgroundPreclerkship clinical-skills training has received increasing attention as a foundational preparation for clerkships. Expectations among medical students and faculty regarding the clinical skills and level of skill mastery needed for starting clerkships are unknown. Medical students, faculty teaching in the preclinical setting, and clinical clerkship faculty may have differing expectations of students entering clerkships. If students’ expectations differ from faculty expectations, students may experience anxiety. Alternately, congruent expectations among students and faculty may facilitate integrated and seamless student transitions to clerkships.AimsTo assess the congruence of expectations among preclerkship faculty, clerkship faculty, and medical students for the clinical skills and appropriate level of clinical-skills preparation needed to begin clerkships.MethodsInvestigators surveyed preclinical faculty, clerkship faculty, and medical students early in their basic clerkships at a North American medical school that focuses on preclerkship clinical-skills development. Survey questions assessed expectations for the appropriate level of preparation in basic and advanced clinical skills for students entering clerkships.Results Preclinical faculty and students had higher expectations than clerkship faculty for degree of preparation in most basic skills. Students had higher expectations than both faculty groups for advanced skills preparation.ConclusionsPreclinical faculty, clerkship faculty, and medical students appear to have different expectations of clinical-skills training needed for clerkships. As American medical schools increasingly introduce clinical-skills training prior to clerkships, more attention to alignment, communication, and integration between preclinical and clerkship faculty will be important to establish common curricular agendas and increase integration of student learning. Clarification of skills expectations may also alleviate student anxiety about clerkships and enhance their learning.

Learning in the Real Place

“…A recent study reported that students had higher expectations of their own skill development than clinical faculty had. 24 This finding may be related to students' desire to impress faculty so that they "earn" learning opportunities.…”

What We Learned from the Experience of an Introduction to Surgery Class for First Grade Premedical Students

“…8,9 In our experience, written test performance is statistically associated with non-compliance scores, suggesting that proper timely intervention by the class director to decrease non-compliance score may modify student competence. Long-term student outcomes need to be evaluated to determine if our observations and class will be effective in improving premedical education.…”

A Core Physical Exam for Medical Students

“…The high level of agreement on maneuvers between PDCDs and IMCDs may bridge the gap between preclinical faculty, clerkship faculty, and students' differing expectations of what skills are needed on entry to clerkships. 9 The third issue raised by our survey respondents was how to address the need for students to practice and achieve proficiency in certain technically challenging maneuvers that may require regular practice, even though they might not be clinically necessary. Their concern is supported by Wu et al, 23 who showed that clerkship students have relatively low self-confidence in certain skills such as the fundoscopic exam, measuring jugular venous pulse, and detecting thyroid nodules.…”

“…Research suggests that students find performing a comprehensive set of physical exam maneuvers overwhelming and may have higher performance expectations of themselves than their educators do of them. 9 Other research demonstrates that students have difficulty effectively applying what they learn in the preclerkship curriculum to clinical cases. 10 It is also possible that if students are asked to routinely perform many maneuvers without clinical or educational rationale, they may begin to feel that the physical examination as a whole lacks utility.…”