Clinical skills center attending: an innovative senior medical school elective

Although residents are expected to assume teaching responsibilities, the traditional medical school curriculum does not formally prepare students for the teaching role. In 1999 an elective was developed to provide senior medical students with opportunities to acquire instructional and leadership skills by participating in clinical education activities as a clinical skills center attending. This elective also allowed the senior student to explore academic medicine as a potential career choice.

During the four-week elective, a senior student acted as an attending in the clinical skills center (CSC), a state-of-the-art facility that is designed and equipped for teaching and testing medical skills. (The CSC has ten fully operational patient examining rooms for student-patient interaction, and each room is equipped with dual cameras and two-way audio response capability.) The participating student spent approximately 40 hours per week teaching clinical skills to freshmen, sophomore, and junior medical students and assisting with testing activities for the Colleges of Medicine, Pharmacy, and Nursing. A specific requirement for full credit was writing an objective standardized clinical examination (OSCE) case. The case format required development of a checklist for minimal competencies of the examinee and suggested techniques for evaluating those competencies. Another specific requirement was that the senior student participate in the training of standardized patients to portray one or more OSCE cases. Other activities were tailored to meet the needs of the senior student and/or users of the CSC. Two course co-directors provided guidance for all students. Evaluation was on a "pass/fail" basis. There were no written or oral exams. The purpose of the elective was achieved through individual research and completion of the assigned activities.

This elective was first offered to senior medical students at during 1999-2000. Each student participated in an average of ten teaching sessions or assessments. To date, six senior students, five women and one man, have completed the elective. These students entered family medicine, pediatrics, internal medicine, psychiatry, and surgery residencies. Participants were asked to rate the elective using a five-point Likert-type scale with 5 signifying "strong agreement." The response rate was 67%. These students felt the requirements were adequate (4.75) and said they would recommend it to other senior students (4.75). They agreed that the objectives were clear and attainable (4.5) and that it better prepared them to teach as resident (4.25). Areas of weakness identified were the elective's ability to increase the student's understanding of medical education (3.75) and meet the student's expectations (4.0). The organization of the elective (4.0) could be improved as well. Most participants were interested in academic medicine before (4.25) and after (4.75) the experience. We plan to follow these students over time to see what careers they eventually pursue. Although our experience is limited and the student population is small, we believe the elective is an effective method for developing teaching skills and helping the upper-level medical student who is interested in education to better understand the nature and function of academic clinical medicine.