The third-year medical student clerkship in obstetrics and gynecology is often the first introduction many students have to the field of women's health care.1 This third year of medical school is a time when the majority of medical students will make their future career decisions.1 Because the number of applications into the field of obstetrics and gynecology has been decreasing nationally, a concerted effort by the faculty at Denver Health Medical Center, an affiliate of the University of Colorado, was made to reorganize the third-year clerkship. The goal of this reorganization was that the interest in obstetrics and gynecology as a career would increase and the students would find the clerkship more rewarding.
Denver Health Medical Center is a public hospital associated with the University of Colorado Health Science Center. The students rotate for 6 weeks, with their time divided between obstetrics and gynecology. The students rotate at either the university hospital or the public hospital, with several students in each rotation being placed at an off-campus site. Denver Health Medical Center performs 3,600 deliveries and 500 surgical procedures annually. Before the initiation of the new structured rotation, there was no organized format for the third-year medical student clerkship.
Formerly, the students presented to the hospital on the first day of the rotation. They were divided into 2 groups, 1 group on obstetrics and 1 on gynecology for the 6-week period. At the end of the course, an overall clinical evaluation for each student was given, and this was averaged with the written examination. There was no direct feedback during the rotation, no organized lecture series, and no objective, structured clinical examination performed. The evaluations of the course ranged from average to good, but there was little enthusiasm about the field of obstetrics or the course in general.
MATERIALS AND METHODS
After approval of the Institutional Review Board of the University of Colorado, the student evaluations were reviewed. A new structure for the basic obstetrics and gynecology rotation was instituted in 2001 at Denver Health Medical Center. After a brief session with a live model to learn pelvic exams, the rotation begins with an explanation of the grading process, written expectations of the course, and a 2-day lecture on basics of obstetrics and gynecology given by all the attending staff. This was followed with an orientation to the hospital, weekly problem-based case presentations from all faculty members in their area of expertise, as well as a suturing laboratory and an ethics discussion. An off-site journal club with the faculty and residents occurs once during the rotation. The students have an initial meeting with the chairman, a midterm evaluation, and a final meeting to discuss the course and any performance issues. The final evaluation consisted of an objective, structured clinical examination, a written history and physical examination on both an obstetric and a gynecology patient, performance in the hospital, and the standardized national board examination. Throughout the course, students were counseled immediately on their individual performance by the program director or the chairman of the department.
A written evaluation from each individual student on each faculty member was obtained at the end of the course, with a scale of 1 to 5 used for tabulate students’ responses. A series of questions was asked, with 1 being the best and 5 being the worst. The scores were then recorded over each rotation. The ratings on each question were compiled and analyzed over a 3-year period. The questions covered such things as quality of the instructor's teaching during this clinical experience, constructiveness of feedback, promptness of this feedback, instructor's commitment and enthusiasm for teaching, extent to which the instructor enhanced the resident's professional development during this clinical course, and the extent to which the instructor was a positive role model.
Before the initiation of the complete program, the scores from the evaluations were compared with the scores after implementation of the program. A Wilcoxon rank sum analysis was used comparing the responses of 1 and 2 for the year before initiation and afterward for the faculty and overall evaluation of the course.
The evaluations from 60 students each year between 1999 and 2001 were analyzed. Individual ratings for the 6 faculty who were present throughout the entire period were included. In all areas of evaluation, there was significant improvement in the students’ perception of the course (Table 1). It is noteworthy that between the years 1999 and 2000, the number of students interested in obstetrics and gynecology was 3 and 4, respectively, whereas in 2001 and 2002, the first 2 years after implementation of the new process, 6 and 7 students, respectively, declared interest in this field. The students’ evaluation of the course improved and increased with more faculty involvement. The components that contributed to the students’ satisfaction were case presentations by the faculty and promptness of feedback.
The evaluations taken at the end of the rotation reflected significant improvement in the areas of quality of instructor teaching, commitment and enthusiasm for teaching, enhancement of professional development, and serving as a positive role model. Although subjective, these are reflective of the many qualities educators aspire to reach. Furthermore, the students were eager to have feedback and noted it to be more effective when it was constructive and given in a timely manner. Teaching has become a priority for the department. At the end of the first 2 years of implementation, a total of 13 students expressed interest in obstetrics and gynecology as a career compared with a total of 7 for the 2 years immediately before implementation. Satisfaction with the course has improved significantly even for the students who did not choose a career in obstetrics and gynecology.
In summary, this is a study comparing the differences of a loosely organized approach to the rotation versus a structured, complete approach. There is literature to support that a third-year clerkship will improve when it is integrated into a structured format and prompt feedback is given.2–5 Using this approach at our institution has significantly increased the satisfaction of the medical students during their third-year clerkship. It appears obvious that the more the faculty is involved with the student in a structured environment, the more the students feel that their educational needs are being met, and they have a more positive response to the rotation.
A commitment from the leadership of the department and the faculty can change the entire perception of the third-year clerkship. Small organizational changes made significant difference in our students’ perception. None of the faculty had to change or limit their clinical or research time. An organized structured rotation can have a positive impact on the students’ perception of obstetrics and gynecology and may affect their future career choices.
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5. Erickson SS, Bachica J, Bienstock J, Ciotti MC, Hartmann DM, Cox S, et al. The process of translating women's health care competencies into educational objectives. Am J Obstet Gynecol 2002;187(suppl 3):525–7.