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Academic Medicine:
doi: 10.1097/ACM.0b013e31823a9684
Letters to the Editor

Management Lessons for Improving Medical Students' Clerkship Experience

Clement, R. Carter; Derman, Peter B.; Moss, Haley A.

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MD/MBA candidate, Perelman School of Medicine and the Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania. (Clement, Moss)

MD/MBA candidate, Perelman School of Medicine and the Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania; derman@mail.med.upenn.edu. (Derman)

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To the Editor:

As joint-degree MD/MBA students, we have had the opportunity to reflect on our medical education in the context of management concepts taught in business schools, employed across industries, and supported in academic literature. Fortunately, our professors of “Management of People at Work” introduced us to the theory of job design, a management tool we found particularly informative. This theory posits that workers are most motivated by positions that optimize satisfaction in three categories: responsibility, feedback, and meaningfulness.1 The application of this theory reveals why many of our MD/MBA classmates reported much higher job satisfaction as upper-level students (substitute interns, or “subinterns”) than as entry-level students (clerks) and offers lessons for improving the clerkship experience.

Responsibility. Our subintern experience was more rewarding in part because we held greater responsibility for patients. Any preparation for clerks (e.g., transitional courses) that allows them to take more responsibility would likely enhance their motivation and job satisfaction.

Feedback. The most meaningful feedback comes directly from one's work, such as when a student suggests a higher diuretic dose and subsequently observes an improvement in the patient's breathing. Subinterns are better positioned to receive this type of feedback because they are more involved in patient care. Feedback to clerks usually comes from supervisors; however, it can still make a difference as long as it is prompt, specific, and action oriented.

Meaningfulness. Every student strives to provide quality patient care. Subinterns experience more meaningfulness in their role because they make larger contributions toward such care. Clerks, whose clinical contributions are inherently less extensive, might have a more meaningful experience if course directors could convincingly reframe the goal of the clerkship to be more about learning how to help future patients and less about treating current ones.

We believe that if clerkship directors focus on the way students are managed—using such tools as job design theory—both students and schools will benefit.

R. Carter Clement

MD/MBA candidate, Perelman School of Medicine and the Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania.

Peter B. Derman

MD/MBA candidate, Perelman School of Medicine and the Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania; derman@mail.med.upenn.edu.

Haley A. Moss

MD/MBA candidate, Perelman School of Medicine and the Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania.

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Reference

1 Hackman JR, Oldham GR, Janson R, Purdy K. A new strategy for job enrichment. Calif Manage Rev. 1975;17:57–71.

© 2012 Association of American Medical Colleges

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