A strategy to standardize the learning of core clerkship objectives

Consistent and effective implementation of clinical clerkship objectives remains elusive. Using the behavioral principles of self assessment, active learning and learner differences, we designed an objectives checklist to ensure that all students mastered a core body of internal medicine (IM) knowledge and to facilitate self-directed learning.

We developed a 54-item learning objectives checklist card in the IM clerkship. In a randomized controlled trial by clerkship site and block, students in the intervention group received the checklist card and were instructed to obtain sign off on objectives by faculty and housestaff and to seek teaching, literature, and clinical experiences to satisfy objectives unmet through routine activities. Intervention group faculty and housestaff were oriented to the use of the checklist. Both intervention and control groups received the course syllabus. We assessed learning with faculty and housestaff evaluations, student knowledge self-assessment, and a written examination. Satisfaction with the cards was assessed with written evaluations.

There were no significant differences in ward evaluations, examination scores or self-assessed knowledge between students using the learning objectives cards and control groups. Faculty were more likely than students to agree that objectives cards improved education.

An intervention designed to guide students in the use of a learning objectives card did not enhance learning as assessed by ward evaluations, a written examination, and satisfaction surveys. It is possible that more sensitive outcome measures could detect differences in knowledge for students using learning objectives checklist cards.