A decentralized clerkship: strategies for standardizing content and instruction

Course decentralization in a required family medicine clerkship occurred because additional teaching and clinical resources were needed to meet the educational goals and objectives of an entire class of medical students. The decentralized teaching effort, which consisted of a variety of practice models, had the potential for an inconsistent exposure to the required educational content of the clerkship. Course monitoring and evaluation also was difficult because of the logistics of the various teaching sites. In order to minimize inconsistent content exposure, efforts to standardize course requirements occurred through criterion-based faculty and teaching site selection, initial faculty development, and provision of appropriate library resources. Continuous standardization consisted of required periodic faculty development, frequent evaluation of faculty and teaching sites, and comparative studies of student performance. Standardization of some of the students' patient care experience resulted from the use of predetermined list of required clinical encounters. A computer assisted evaluation of students' patient experience log defined the actual student patient care population at various teaching sites and compared this to course requirements. Deficits in patient care experiences were addressed by providing either the appropriate patient encounters or alternative experiences through print, audiovisual, or teaching sessions.