Monitoring students' clinical experiences during a third-year family medicine clerkship

To demonstrate the importance of monitoring the clinical experiences and types of supervision that students receive in physicians' offices, in order to ensure quality control during a required clerkship.

In a documentation system introduced in 1991-92, third-year students in the family medicine clerkship at the University of North Carolina at Chapel Hill School of Medicine were asked to complete an optical scan card for every patient they saw. The card information consisted of demographic data, patient continuity, medical problems, types of histories and physical examinations, patient education issues, primary care procedures, and type of supervision. The data were collected from 293 students placed in 63 practices from December 1991 through November 1993.

Hypertension, health maintenance, and upper respiratory infection were the most frequently recorded medical problems. Although the students obtained adequate experience performing focused histories and physicals, their experiences with certain physical examinations (breast, rectal, and genital) were inconsistent. Patterns of supervision by the preceptors varied among practices.

Although the validity of the data has not been assessed, previous literature and other information indicate that the documentation system successfully described the students' clinical experiences. The benefits of implementing such a monitoring system include highlighting the students' lack of certain experiences and making comparisons across sites in order to encourage change among preceptors.