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Closing the Gap Between Preclinical and Clinical Training

Impact of a Transition-to-Clerkship Course on Medical Students’ Clerkship Performance

Ryan, Michael S. MD, MEHP; Feldman, Moshe PhD; Bodamer, Cheryl PhD, RN; Browning, Joel; Brock, Ellen MD; Grossman, Catherine MD

doi: 10.1097/ACM.0000000000002934
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Problem: Medical students typically perform worse on clinical clerkships that take place early in their training compared to those that occur later. Some institutions have developed transition-to-clerkship courses (TTCCs) to improve students’ preparedness for the clinical phase of the curriculum. Yet, the impact of TTCCs on students’ performance has not been evaluated.

Approach: The authors developed and implemented a TTCC at Virginia Commonwealth University School of Medicine and measured its impact on students’ clerkship performance. During the 2014-2015 academic year, they introduced a 2-week intersession TTCC. The goal was to improve students’ readiness for clerkships by fostering the knowledge, skills, and attitudes required to care for patients throughout a hospitalization. The TTCC included panel discussions, skills development sessions, case-based workshops, and a 4-station standardized patient simulation. The authors assessed the feasibility of designing and implementing the TTCC and students’ reactions and clerkship performance.

Outcomes: The total direct costs were $3,500. Students reacted favorably and reported improved comfort on entering clerkships. Summative performance evaluations across clerkships were higher for those students who received the TTCC with simulation compared to those students who received the standard clerkship orientation (P < .001 - .04, Cohen’s d range = 0.23 - 0.62). This finding was particularly apparent in those clerkships that occurred earlier in the academic year.

Next Steps: Future plans include evaluating the impact of the TTCC on student well-being and incorporating elements of the TTCC into the preclinical curriculum.

M.S. Ryan is associate professor and assistant dean for clinical medical education, Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289.

M. Feldman is associate professor and assistant director for research and evaluation, Center for Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

C. Bodamer is assistant professor and simulation educator, Center for Human Simulation and Patient Safety, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

J. Browning is director of academic information systems, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

E. Brock was professor of obstetrics and gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, at the time this work was completed. She is retired now.

C. Grossman is associate professor and interim medical director of human simulation, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A729.

Acknowledgements: The authors would like to thank Sally Santen, MD, PhD, for critically reviewing an earlier version of this article.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This work was deemed exempt from ethical review by the institutional review board at Virginia Commonwealth University.

Previous presentations: This work was presented as an oral abstract at the Association of American Medical Colleges Learn Serve Lead annual meeting in Austin, Texas, on November 5, 2018.

Correspondence should be addressed to Michael S. Ryan, Virginia Commonwealth University School of Medicine, 1201 E. Marshall St., Suite 4-200, Box 980565, Richmond, VA 23298-0565; telephone: (804) 828-4589; email: michael.ryan1@vcuhealth.org; Twitter: @MichaelSRyanMD.

© 2019 by the Association of American Medical Colleges