Using patient encounter logs for mandated clinical encounters in an internal medicine clerkship

Patient encounter logs help assess a student's educational experience. The use of a grading incentive linked to the mandatory documentation of prespecified clinical encounters has been insufficiently studied.

Given this, our objectives were to determine (a) if mandating student exposure to patients with 18 key training problems leads to the successful documentation of these encounters, (b) the degree of difficulty students and clerkship directors experienced in meeting these mandates, (c) the accuracy of mandated log entries, and (d) how often the log entries were questioned or rejected by preceptors.

Ninety-two 3rd-year internal medicine students and 6 internal medicine clerkship directors at 9 geographically dispersed hospitals and 30 ambulatory sites participated in the study. Over a single academic year, we directly measured the completion rate of mandated logs, the degree of their accuracy as judged against faculty-generated logs of two required videotaped standardized patient encounters, and the percentage of logs that were not validated. We surveyed students and directors on the perceived degree of difficulty in meeting mandated requirements.

Ninety-eight percent of students met our mandated requirements and 93.8% of students found it "easy" or "very easy" to meet this requirement. The amount of estimated time spent by clerkship directors helping students meet mandated requirements for the entire year was 4.5 hr. The accuracy of submitted logs was 77%; however, almost all inaccurate log entries were "validated" by preceptors.

Mandating encounters is effective in assuring that students document encounters with patients who present with specific clinical problems. The accuracy of our students' mandated logs is similar to previously published data. However, even inaccurate logs were rarely questioned or rejected by preceptors.