What students say about learning and teaching in longitudinal ambulatory primary care clerkships: a...

Ambulatory primary care clerkships have become crucial elements in medical education. Although most such clerkships employ a block-rotation format, an alternative longitudinal approach has been developed. This study examines students' perceptions of learning and instruction occurring during longitudinal ambulatory clerkships.

Characteristics of longitudinal ambulatory primary care clerkships at five medical schools are described. Responses of 429 medical students to a standardized survey administered at these institutions are analyzed to ascertain perceptions of learning and teaching occurring during longitudinal ambulatory clerkship experiences.

Enhancements of interpersonal communication and clinical skills were perceived to be the most positive learning attributes of the longitudinal ambulatory clerkships. No advantage was discerned with respect to disease-pattern recognition or generation of differential diagnoses. While significant inter-institutional variation was present, particularly with respect to instructional format, there was notable agreement regarding several aspects of clerkship-related learning and the adequacy of faculty supervision.

Students perceived that learning during longitudinal ambulatory clerkships had greater impact on skill enhancement than on attainment of knowledge-related objectives. Sources of variation in student opinion, perceptions of learning as a function of career preference, and correlation of students' perceptions of learning to demonstrable changes in their competence require further investigation.