内科クリニシズムにおける職場ベース学習プログラムが医学生の臨床能力を向上させる：後向き比較研究

Clinical competence is a core outcome of undergraduate medical education, yet traditional clerkships often lack structured observation and feedback. This study evaluated the effectiveness of a workplace-based learning program (WBLP) incorporating mini-Clinical Evaluation Exercises (mini-CEX) and Direct Observation of Procedural Skills (DOPS) into an internal medicine clerkship, and its impact on students' clinical competence and learning satisfaction.

This retrospective cohort study analyzed outcomes of fourth-year medical students who completed a 9-week internal medicine clerkship at Zhejiang University School of Medicine between September 2024 and May 2025. Students were categorized into a WBLP group (n = 39) and a control group (n = 38). The WBLP group received structured formative assessments with mini-CEX and DOPS every 1-2 weeks, followed by immediate feedback. Outcomes included knowledge acquisition (multiple-choice question [MCQ] exam), clinical performance (6-station Objective Structured Clinical Examination [OSCE]), and perceptions of the learning environment (satisfaction questionnaire).

Seventy-seven students were included. The WBLP group achieved significantly higher scores in both the MCQ exam (85.3 ± 6.1 vs. 80.2 ± 6.7, p < 0.001) and OSCE (86.4 ± 5.4 vs. 80.9 ± 5.9, p < 0.001), particularly in history taking, clinical reasoning, and procedural skills. No significant difference was observed in CPR performance. Students in the WBLP group reported greater satisfaction with feedback, patient communication, and overall learning experience (p < 0.01).

Integrating structured workplace-based assessments into clerkship training significantly enhances students' clinical competence and improves their learning experience. These findings provide preliminary evidence to support broader implementation of WBLP in undergraduate medical curricula.