Medical student patient experiences before and after duty hour regulation and hospitalist support

With the growth of hospitalist services and the reduction in residency work hours, medical education has changed dramatically. The objective of this study was to examine changes in junior medical student-patient encounters after initiation of residency work hours and implementation of a large hospitalist practice at our academic medical center.

Medicine clerkship students from 2002-2007 recorded the number of hospital patients and their principal diagnoses cared for during a 6-week block rotation. Comparisons were made between clerkship experiences among students in 2002-2004 and 2005-2007 for number of patients and diversity of patient diagnoses seen. Data from the 2004-2005 transition period, when teams fluctuated during implementation of the hospitalist service, were excluded.

A total of 4,697 patients were seen by students during the two periods, and patient logs for 154 students (3,253 patients in 2002-2004) and 120 students (1,444 patients in 2005-2007) were compared. The mean number of patients directly cared for by students on their junior medicine clerkship dropped from 21 patients (2002-2004) to 12 patients (2005-2007) per student (p < 0.001). Compared to 2002-2004, fewer students from 2005-2007 helped manage patients with chest pain (85.7% vs. 74.2%, p = 0.016), pancreatitis (66.9% vs. 23.3%, p < 0.001), pneumonia (69.5% vs. 54.2%, p = 0.009), gastroenteritis (45.5% vs. 20.8%, p < 0.001), or cellulitis (46.8% vs. 19.2%, p < 0.001). Alternatively, students from 2005-2007 saw more patients with abdominal pain (64.9% vs. 79.2%, p = 0.010), anemia (44.8% vs. 70.8%, p < 0.001), mental status changes (32.5% vs. 51.7%, p = 0.001), failure to thrive (16.2% vs. 53.3%, p < 0.001), and endocrine disorders (including diabetes, thyroid disorders, Addison's, 51.3% vs. 74.2%, p < 0.001).

With institutional and residency changes, junior medicine clerkship students had fewer opportunities for direct care of patients and encountered a different mix of patient diagnoses. Increasingly during their junior medicine clerkship, students may not have exposure to basic medical conditions, which may affect their ability to care for future patients.