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Current Landscape of the Internal Medicine Clerkship: A National Survey
Ryan Nall1, Amber Pincavage2, Temple A Ratcliffe3
1University of Florida College of Medicine, Health Science Center, Gainesville, FL, USA. ryan.nall@medicine.ufl.edu.
Background:
The current national landscape of the core internal medicine (IM) clerkship structure is not known. The last study of the IM clerkship structure was conducted in 2017. Since then, the COVID-19 pandemic prompted clerkship directors (CDs) to reevaluate their curriculum and educational strategies. Additionally, there have been national changes in medical education since the last survey.
Objective:
To describe the current education structure in the core IM clerkship.
Design:
A nationally representative, cross-sectional survey of IM CDs at U.S. medical schools. One thematic section addressed the current structure of the core medicine clerkship.
Participants:
One hundred forty-one CDs with membership in the Clerkship Directors in Internal Medicine (CDIM).
Main Measures:
IM core clerkship structure descriptive data, including duration, educational models, inpatient experiences, ambulatory experiences, and structural changes since the pre-pandemic period.
Key Results:
The response rate was 80.9% (114/141). Most clerkships use a traditional block model (87.7%) with a median length (IQR) of 8 (0) weeks. IM-specific ambulatory experiences were required in 49.6% of clerkships. The majority (92.0%) of clerkships have returned to in-person didactics since the pandemic. The most common challenges CDs face include ensuring students receive formative feedback, recruiting enough faculty preceptors, and delivering faculty development. Compared to before the pandemic, 34.2% of clerkships report an increase in students per rotation, and 19.3% report a decrease in clerkship length.
Conclusions:
Most IM core clerkships remain structured as traditional block rotations. A notable number of CDs report an increase in students per rotation and a decrease in clerkship length post-pandemic. Our findings demonstrate that CDs are navigating increasing complexity in the learning environment, as well as structural, institutional, and system-level challenges. Despite this, CDs have maintained stable learner density on rotations and ambulatory training in the IM clerkship.
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