A comparison of inpatient and outpatient experiences during an internal medicine clerkship

Our 12-week internal medicine clerkship contains an 8-week inpatient and a 4-week outpatient component. This study examines the differences between these components, comparing diagnoses seen, category of learning, and student contribution to patient care.

Students used logbooks to record diagnoses, workup, and treatment for each patient they encountered. Additionally, students categorized the type of learning from each encounter (ie, pathophysiology, evaluation/workup, treatment, differentials, patient education/counseling, or technical skills) and ranked their involvement in patient care using a 1 to 5 scale (1=little; 5=significant). Comparison of inpatient and outpatient data was made using chi-square analysis or Student's t-test.

One thousand three-hundred twenty-four patient encounters were analyzed (597 inpatient; 727 outpatient). The top 10 diagnoses in each setting were markedly different. Students reported that patient encounters in the inpatient setting were more likely to have involved learning about disease pathophysiology (21% inpatient vs 15% outpatient; P <0.001) whereas in outpatient encounters, students reported that they learned more about education/counseling (6% inpatient vs 11% outpatient; P <0.0001) and evaluation/workup (10% inpatient vs 15% outpatient; P <0.0001). Students' perception of their involvement in patient care did not differ significantly between the 2 settings (mean rank inpatient 3.69+/-0.87; mean rank outpatient 3.75+/-0.85; P=0.95).

Despite spending less time with each patient during outpatient encounters, students considered their contribution to patient care equally significant to that for inpatients, suggesting that students have an active role in both settings.