Hospital-based versus community-based clinical education: comparing performances and course evaluations by students...

Increasing use of outpatient settings for clinical education raises the question of their effectiveness compared with that of inpatient settings.

At the University of Minnesota Medical School-Minneapolis in 1987-88, the 190 second-year students participated in a six-week tutorial rotation introducing them to clinical pediatrics: 52 (27%) were in hospital settings and 138 (73%) were in community outpatient settings. Almost all the students (178) evaluated their rotations by responding to both structured and open-ended questions, using a Likert scale for the structured questions. At the completion of the second year, all 190 students took an objective structured clinical examination (OSCE) that included five pediatrics stations. Student's t-test was used to compare (1) the mean ratings the hospital-based and community-based students gave their pediatrics rotations and (2) the mean scores earned by the two groups of students on the five pediatrics stations in the OSCE.

There were no statistically significant differences between (1) the two groups' mean ratings of the clinical experience overall or of the quality of teaching or (2) the groups' mean scores on any of the OSCE stations.

That the hospital-based and community-based students performed comparably on the OSCE and gave similar evaluations of their pediatrics rotations supports the use of community practitioners to provide students with their initial clinical training. Moreover, community-based teaching sites replicate situations in which most students will eventually practice medicine.