Student Perceptions of Their Impact on the Quality of Patient Care during Third-Year Core Clerkships

Much of the literature on value-added student roles focuses on medical student participation in health systems science-related learning experiences. Our study sought to understand how students perceive that they improve patient care in the clinical setting.

We reviewed qualitative data from the 2020-2021 academic year collected from all third-year medical students (N = 119) at the end of each of their clerkships in response to the prompt "How were you able to improve the quality of patient care?" Data were analyzed using a thematic approach of the responses from all clerkships (Family Medicine, Internal Medicine, Surgery, Neurology, Obstetrics and Gynecology, Psychiatry, Pediatrics). Three independent coders reviewed all of the responses, created a preliminary coding framework and corresponding themes, and then reconciled and revised codes and themes to construct a final code book.

We identified seven themes regarding student perceptions of their impact on the quality of patient care. Five themes were patient facing: spending more time with patients, providing patient-centered care, completing care tasks, using evidence-based medicine, and participating in the healthcare team. Two student-facing themes also were identified, and several students reported no value-added role.

Most of the students perceived that they improved care quality via numerous value-added roles during their core clerkships. Many of these roles could be mapped to the Entrustable Professional Activities framework, with notable additions, including care related to social determinants of health, patient-centered communication, and patient education. These findings have implications for clinical teaching and assessment of students, clinical faculty development, and the future of Entrustable Professional Activities iterations.