Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students

Background: Medical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships. Intervention: Our four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally ‘non-teaching’ service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills. Outcome: In the elective’s first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students’ self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans. Conclusions: Students found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students’ perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource – the hospital medicine ‘non-teaching’ service – and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation. Abbreviations: A&P: Assessment and plan; H&P: History and physical; ILP: Individual learning plan