Medical schools fail to adequately prepare students for basic patient interaction before they enter clinical settings in their last years of medical school, according to a group of studies published this month in Academic Medicine.
In the studies, researchers identified problems with the education and performance of medical students in a variety of disciplines. Doctors also made suggestions of curricular and policy changes that might help address these concerns. Academic Medicine is a peer-reviewed journal on medical education published by the Association of American Medical Colleges (AAMC).
In one study from Johns Hopkins University, 190 clerkship directors at 32 medical schools were asked to evaluate the abilities of the medical students in their clerkships. In clerkships, medical students, usually in their third year of medical school, work in hospitals and doctors’ offices under a doctor’s supervision.
Thirty to 50 percent of respondents said students were inadequately prepared for the clerkships, namely deficient in the skills of interviewing and physical examination. Other skills evaluated included communication skills, epidemiology, professionalism, and understanding life-cycle stages and the changes in the health-care system.
Editor of Academic Medicine and Senior Vice President for medical education at the AAMC Dr. Michael Whitcomb said clerkship directors’ expectations of entering students might be too high.
“The medical school faculty as a whole [might] not believe students should have attained the level clerkship directors expect — that’s one possibility,” Whitcomb said.
Whitcomb said an evaluation of the medical school curricula might also be in order.
“If in fact [clerkship directors’] expectations are appropriately aligned with what the school [means to provide] — the school needs to look at what they’re doing in the first two years and better prepare students to meet those expectations,” Whitcomb said. “[The study is] intended to raise the issue for individual schools to evaluate their own educations and make conclusions that best fit their overall educational goals.”
The second study from Hopkins concentrated on the quality of medical education in care for the chronically ill. Researchers interviewed directors of required courses at 16 U.S. medical schools to determine what skills they deemed important in chronic care, and whether the schools met those needs.
Dr. Hoangmai H. Pham, senior health researcher at the Center for Studying Health System Change, said while the number of chronically ill patients is rising, students are not taught how to deal with these long-term illnesses.
“The burden of care is going to shift more and more to chronic illness,” Pham said. “Medical students learn acute care — care for an acute complication of that chronic illness [but not the long-term illness].”
Pham said the directors agreed on the importance of many “competencies,” necessary for chronic care, but curricula often failed to address these needs.
“Because of [rising numbers of chronically ill patients], there’s been a lot of discussion in the medical education community about how [medical schools] should respond to those concerns,” Pham said. “They were cognizant of those priorities and concerned … but the acceptance of that vocabulary has not translated into curricular change.”
In a third study Dr. Eric Holmboe, associate professor of internal medicine at the Yale School of Medicine, approached the clinical-skill deficiencies of students and residents from a different perspective.
Synthesizing the findings of many studies, Holmboe stressed the importance of faculty members and physicians’ ability to accurately evaluate the clinical performance of students and residents.
“The evaluation of clinical skills by faculty must be given higher priority by medical school deans, department chairs, and residency program directors,” Holmboe wrote in the study. “A greater emphasis on faculty development in clinical skills and evaluation will also be needed.”
He said faculty evaluations are crucial to helping students recognize and amend deficiencies in clinical practice.
“We know from other studies that just because somebody’s really smart, doesn’t mean they’re good with skills like physical exams and counseling,” Holmboe said. “It’s a separate skill set that takes training. Faculty are needed to observe them in real clinical settings.”