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Perceptions and Attributions of Third-Year Student Struggles in Clerkships: Do Students and Clerkship Directors Agree?

O'Brien, Bridget PhD; Cooke, Molly MD; Irby, David M. PhD

doi: 10.1097/ACM.0b013e31814a4fd5
Clinical Education

Purpose: To explore the congruence between students' and clerkship directors' perceptions and attributions of students' struggles during the transition to clerkships.

Method: Focus groups and interviews were conducted with third- and fourth-year medical students and clerkship directors at 10 U.S. medical schools in 2005 and 2006. Schools were selected to represent diverse locations, sizes, and missions. Interviews and focus groups were recorded, transcribed, and analyzed thematically.

Results: Students' struggles included understanding roles and responsibilities, adjusting to clinical cultures, performing clinical skills, learning the logistics of clinical settings, and encountering frequent changes in staff, settings, and content. Clerkship directors recognized students' struggles with roles and responsibilities, performing clinical skills, and adjusting to clinical cultures, but they also focused on students' difficulties applying knowledge to clinical reasoning and engaging in self-directed learning.

Conclusions: Clerkship directors and students recognize many challenges associated with learning and performing in the clerkships. Students' perspectives suggest that these challenges may be more complex than clerkship directors and clinical teachers realize and/or are capable of addressing. The areas in which clerkship directors' and students' perspectives are not congruent point to directions for future research that can guide curricula and teaching strategies.

Dr. O'Brien is a research scholar, The Carnegie Foundation for the Advancement of Teaching, Stanford, California.

Dr. Cooke is professor of medicine, William G. Irwin Endowed Chair, and director of the Haile T. Debas Academy of Medical Educators, University of California–San Francisco School of Medicine, San Francisco, California, and senior scholar, The Carnegie Foundation for the Advancement of Teaching, Stanford, California.

Dr. Irby is professor of medicine and vice dean for education, University of California–San Francisco School of Medicine, San Francisco, California, and senior scholar, The Carnegie Foundation for the Advancement of Teaching, Stanford, California.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. O'Brien, The Carnegie Foundation for the Advancement of Teaching, 51 Vista Lane, Stanford, CA 94305; telephone: (650) 566-5538; fax: (650) 326-0278; e-mail: (OBrien@carnegiefoundation.org).

© 2007 Association of American Medical Colleges