Medical students inadequately prepared for clinical rotations, caring for chronically ill

Limitations in the curricula of American medical schools may be preventing students from getting enough basic skills training to succeed in clinical settings, according to two Johns Hopkins studies published in the January issue of the journal Academic Medicine.

The first study indicates that medical students do not receive enough training during the first two years of medical school to adequately prepare them for the clinical rotations they perform during the third and fourth years. The second study demonstrates that course directors greatly vary in their teaching of how to care for the chronically ill, a growing population in the United States.

"Medical schools across the country are examining how they train medical students, and looking for new and better ways to do that," says Eric Bass, M.D., senior author of both studies and associate professor of medicine at Hopkins. "We conclude that many medical schools may need to give more attention to the clinical competency preparation of students for the core clerkships. We need to ensure that our students offer the best care possible, regardless of the specialty they choose."

A new course in patient-physician communication at Hopkins is designed to help address the issue, according to Donna M. Windish, M.D., lead study author and postdoctoral fellow in medicine at Hopkins. In the six-week course, offered during the second year of medical school, students are split into groups of six, paired with one or two faculty members, and discuss communication skills and reasoning. The coursework involves role playing, interviewing of actors portraying patients and incorporating patients' wishes in making decisions.

In the first study, Bass and colleagues surveyed 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology and psychiatry from 32 medical schools around the country. They asked directors to rate the level of student preparation (n

Contact: Karen Blum
Johns Hopkins Medical Institutions

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