title: Casemix in an internal medicine clerkship: educational value of the clinical problems seen.
abstract: OBJECTIVE
  To evaluate the casemix seen during an internal medicine clerkship and to assess the educational value of the problems seen.
  
  
  METHODS
  A modified Delphi-group opinion technique was used to develop a clerk log that included priority problems for internal medicine. Over a 12-month period, clerks recorded their exposure to the problems seen during their eight-week rotations. General internists rated the importance of each of the problems on a three-point scale.
  
  
  METHODS
  The inpatient internal medicine services in six university teaching hospitals.
  
  
  METHODS
  All clinical clerks in a single undergraduate year recorded their experiences. All university-based general internists participated in rating problem importance.
  
  
  RESULTS
  The final approved log contained 72 problems, 64 of which received importance ratings greater than or equal to 2 on the three-point scale. The frequency of clerk exposure per problem was high and the correlation between frequency of exposure and importance was good. Ten important problems had relatively low exposure and four problems of lower importance had high exposure.
  
  
  CONCLUSIONS
  The clinical clerks were exposed to a broad spectrum of diseases, but some key problems were not well represented on the wards. Alternative strategies, including increased ambulatory care exposure, will be required to complete the exposure and to assure that the quality of patient exposure matches the quantity.
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: McLeod
authors.forename: L
authors.initials: L
authors.lastname: Snell
mesh_terms: D002982:Clinical Clerkship; D003697:Delphi Technique; D003953:Diagnosis-Related Groups; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D011340:Problem Solving