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A SURVEY OF MILITARY RESIDENCIES REGARDING 4TH‐YEAR MEDICAL SCHOOL CLERKSHIPS

Satin, A. J. MD; Hines, J. F. MD; Rosa, C. MD; Armstrong, A. Y. MD; Haffner, W. H. J. MD

Graduate Education

Objective: To determine the value of 4th-year medical student clerkships assessed by military obstetric and gynecologic program directors and residents.

Methods: A questionnaire was sent to all Department of Defense obstetric and gynecologic residency program directors and residents. All of the program directors and 124 of 194 (64%) residents responded, reporting the value of 4th-year medical student clerkships for students entering their programs. Descriptive statistics are reported.

Results: Primary care clerkships were valued most highly by program directors who valued obstetric and gynecologic clerkships at their program sites or audition electives higher than those done at other sites. Residents most highly valued obstetric and gynecologic and intensive care clerkships. Most surgical subspecialties were believed to be of minimal or no value.

Conclusion: For students entering their programs, military program directors placed the highest value on primary care clerkships. Program directors also highly valued obstetric and gynecologic clerkships at their programs, whereas residents considered obstetric and gynecologic and intensive care clerkships to be most helpful.

Despite strong arguments by experienced clinical educators for a broad-based general medical education, many medical schools require little structure regarding curricula for 4th-year students pursuing careers in obstetrics and gynecology. A report of the Association of American Medical Colleges encouraged students to use the 4th year to obtain broad knowledge rather than to concentrate on their chosen field,1 and 87% of chairmen of departments of obstetrics and gynecology advocated no more than one 4th-year clerkship in obstetrics and gynecology to prospective residents.2 The Association of Professors of Gynecology and Obstetrics recommended a core curriculum that does not include obstetric and gynecologic clerkships in the senior year.1 Nevertheless, senior students seeking military residency positions continue to take multiple obstetric and gynecologic clerkships before entering residency training.

This divergence from presumably sound advice might result from an increase in competition for training slots and a perceived need to use electives to audition. During the 15 years before 1996, fewer than six members (4%) of each graduating class of the Uniformed Services University of the Health Sciences applied for obstetric and gynecologic residencies. In each of the last 3 years, however, nearly 10% have applied. That coincides with decreased training positions available and increased quantity and quality of applicants from civilian medical schools with military scholarship obligations. We speculated that those most closely involved with military residency programs are rendering advice different from that outlined above. We asked military program directors and residents to rank the value of 4th-year clerkships for interns entering their programs.

Military residents and program directors believe 4th-year obstetric and gynecologic electives are helpful to students entering their residency programs.

Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas; and Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, D.C.

Address reprint requests to: Andrew J. Satin, MD, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799; E-mail: asatin@usuhs.mil

Received July 10, 1998. Received in revised form October 16, 1998. Accepted November 5, 1998.

© 1999 The American College of Obstetricians and Gynecologists