The learning of 7th year medical students at internal medical--evaluation by logbooks

The purpose of this study was to understand the learning of internal medicine of 7th year medical students through records of the "Learning Passport".

Between June 2005 and June 2006, data from the learning passport (a type of logbook) of 207 7th year medical students at the Department of Internal Medicine, National Taiwan University Hospital (NTUH) were collected.

Among the 19 symptoms/signs listed in the logbook, a large number of students did not learn well on low back pain, skin rash, oedema, oliguria and anxiety/depression; only a few students rated themselves as knowledgeable about anxiety/depression, malaise, skin rash, headache and anorexia. Among the 16 diseases listed, a large number of students did not learn well on chronic obstructive pulmonary disease, stroke, hypertension, coronary artery disease and cirrhosis; only a few students rated themselves as knowledgeable about shock, respiratory failure, consciousness disturbance, sepsis and renal failure. Among the 21 physical examination skills listed, a large number of students did not learn well on the male genitalia, eyes, cognitive status, mental state and the digital rectal examination; only a few students rated themselves as fully competent about cognitive status, mental state, eyes, neurology examination and ENT examination. Among the 11 laboratory skills and image interpretation skills listed, a large number of students did not learn well on blood smear, Gram's stain and specimen sampling; only a few students rated themselves as fully competent about the interpretation of brain computed tomographic (CT) scan, blood smear and Gram's stain. Among the 12 procedures and therapeutic skills listed, a large number of students did not learn well on observation of lumbar puncture, basic cardiopulmonary resuscitation (CPR) and aseptic procedure; only a few students rated themselves as fully competent about basic CPR and transfusion management.

The weak points of intern training conducted by the Department of Internal Medicine, NTUH were revealed by analysis obtained from their logbooks. Thus, we need to strengthen the learning of the interns in these specific parts and assess their performance based on the use of portfolios.