Background: Internal medicine clinical clerkships usually emphasize student
learning of hypothesis generation, problem solving, and patient management
At our school we are concerned that clinical teaching unit (CTU)-based pat
ient exposure is not fostering development of these skills.
Purposes: We evaluated our clerks' interactions with patients on our CTUs t
o document whether the timing of student exposure to patients is conducive
to the acquisition of basic clinical skills.
Methods: Once per week for 8 weeks, lye met with all internal medicine cler
ks on the CTUs at our 4 teaching hospitals. Each student completed a questi
onnaire related to each patient worked up in the previous week; We specific
ally documented when the first interaction occurred with each patient. We a
lso asked students for their perceptions of the learning experiences.
Results: Clinical clerks usually first interact with their patients after i
nitial data acquisition, hypothesis generation, and ordering of investigati
ons and therapy have been completed by other physicians. Students perceive
that meeting patients late in the hospitalization is educationally disadvan
Conclusions: Our clinical clerks usually interact with their patients late
in the hospitalization and are therefore deprived of the opportunity to dev
elop the key clinical skills of hypothesis generation, problem-solving, and
investigation and management of patients.