Interpretive and procedural skills of the internal medicine clerkship: performance and supervision

This descriptive study prospectively examined the performance and supervision of interpretive and procedural skills during an internal medicine clerkship. Students (N = 150) documented having done 7 required and 12 elective skills. Preceptors of required skills were interns (44%), residents (29%), attending physicians (12%), and others (16%). The elective procedures and the percentage of students doing them were as follows: skin tests, 78%; nasogastric tube insertion, 57%; paracentesis, 44%; bone marrow sampling, 35%; lumbar puncture, 34%; thoracentesis, 34%; Papanicolaou smear, 29%; central line placement, 27%; cardioversion, 13%; bladder catheter insertion, 11%; arthrocentesis, 9%; and skin biopsy, 7%. Elective procedures per student ranged from 0 to 9 (mean = 4) and were done less often in the first clerkship group than later in the academic year. Preceptors of electives were interns (46%), residents (39%), and attending physicians (9%). House staff were more likely and faculty less likely to precept electives than required procedures. Students' exposures to these skills are unequal. Their preceptor are generally house staff. To prepare medical students for postgraduate training, technical skills should be specifically addressed in the curriculum.