Pilot experience of a family practice-based combined clerkship

In order to explore alternatives in clinical undergraduate medical education, an experimental Combined Clerkship was developed and implemented on the Grand Rapids campus of Michigan State University. Two third-year medical students spent three half-days per week for 36 weeks seeing patients in the family practice office, of a facluty member. Hospitalized patients from this practice were worked-up and used as the source of inpatient specialty learning. The students attended lectures and took oral and written examinations of all required clerkships, but had no specific hospital assignment during this time. Two hundred nineteen patients were followed by these students, compared to 174 required by the clerkships. All written and oral examinations were passed. In addition to meeting all clerkship objectives, the students cared for 680 outpatients presenting 1,035 ICHPPC-coded problems. The top ten diagnoses were identified collectively and individually, and were compared to other published studies for corroboration of representative patient problems. This project demonstrates that the objectives of required clerkships can be met in an alternative setting that allows the addition of other important experiences.