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The Third-Year Medical Student “Grapevine”: Managing Transitions Between Third-Year Clerkships Using Peer-to-Peer Handoffs

Masters, Dylan E.; O’Brien, Bridget C. PhD; Chou, Calvin L. MD, PhD

doi: 10.1097/ACM.0b013e3182a36c26

Purpose As third-year medical students rotate between clerkships, they experience multiple transitions across workplace cultures and shifting learning expectations. The authors explored clerkship transitions from the students’ perspective by examining the advice they passed on to their peers in preparation for new clerkships.

Method Seventy-one students from three Veterans Affairs–based clerkship rotations at the University of California, San Francisco, School of Medicine participated in a peer-to-peer handoff session from 2008 to 2011. In the handoff session, they gave tips for optimizing performance to students starting the clerkship they had just completed. The authors transcribed student comments from four handoff sessions and used qualitative content analysis to identify and compare advice across clerkships.

Results Students shared advice about workplace culture, content learning, logistics, and work–life balance. Common themes included expectations of the rotation, workplace norms, specific tasks, learning opportunities, and learning strategies. Comments about patient care and work–life balance were rare. Students emphasized different themes for each clerkship; for example, for some clerkships, students commented heavily on tasks and content learning, while in another students focused on workplace culture and exam preparation.

Conclusions These findings characterize the transitions that third-year students undergo as they rotate into new clinical training environments. Students emphasized different aspects of each clerkship in the advice they passed to their peers, and their comments often describe informal norms or opportunities that official clerkship orientations may not address. Peer-to-peer handoffs may help ease transitions between clerkships with dissimilar cultures and expectations.

Mr. Masters is a medical student, School of Medicine, University of California, San Francisco, San Francisco, California.

Dr. O’Brien is associate professor, Department of Medicine and Office of Medical Education, University of California, San Francisco, San Francisco, California.

Dr. Chou is professor, Department of Medicine, University of California, San Francisco, and Veterans Affairs Medical Center, San Francisco, California.

Acknowledgments: The authors wish to thank Anna Chang, MD, Rachael Lucatorto, MD, and Bobby Singh, MD, VALOR faculty who have transcribed these sessions in the past; the Veterans Affairs Department of Medicine, which provided refreshments for the session; and in particular, all VALOR students who participated in this study.

Funding/Support: None.

Other disclosures: None.

Ethical approval: This study was approved by the institutional review board of the University of California, San Francisco.

Disclaimer: The opinions in this article belong solely to the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs or the U.S. government.

Correspondence should be addressed to Dr. Chou, Department of Medicine, Veterans Affairs Medical Center, 4150 Clement St. (111), San Francisco, CA 94121; telephone: (415) 221-4810 ext. 2740; fax: (415) 750-6982; e-mail:

© 2013 by the Association of American Medical Colleges