Does training location influence the clinical skills of medical students?
OBJECTIVE
To examine the benefits of the shift of medical education into ambulatory primary care settings by investigating whether medical students exposed to a common primary care problem (low back pain) in ambulatory care settings develop better clinical skills.


METHODS
In 1995, the authors categorized 420 students from all four North-Carolina medical schools into groups that had previously encountered patients with low back pain in ambulatory primary care settings, tertiary care settings, both, or neither. The clinical skills of the groups were determined using data collected during standardized-patient examination in which students took the history of, physically examined, and chose a diagnostic strategy for patients with acute, uncomplicated low back pain.


RESULTS
In general, there was no difference between the performances of the student groups associated with the settings of their previous encounters with low back pain. On average, the students failed to ask 35% of the history items and failed to perform 35% of the physical examination items. Many students chose inappropriate diagnostic strategies.


CONCLUSIONS
The lack of difference between the groups' clinical performances indicates a need to more rigorously define and evaluate outcomes of education in ambulatory care settings. The generally poor clinical performance of all groups suggests that the current curriculum inadequately teaches clinical skills needed to assess and manage common problems. Clearer expectations of competencies and assurances that preceptors in ambulatory care settings will help students meet those learning objectives might lead to better outcomes.
Steiner
B D
BD
Department of Family Medicine, University of North Carolina, Chapel Hil 27599-7595, USA. bsteiner@med.unc.edu
Cook
R L
RL
Smith
A C
AC
Curtis
P
P
D000553:Ambulatory Care; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002982:Clinical Clerkship; D002983:Clinical Competence; D003479:Curriculum; D003657:Decision Making; D004501:Education, Medical; D004521:Educational Measurement / Q000379:methods; D006761:Hospitals; D006801:Humans; D007858:Learning; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy; D008487:Medical History Taking; D009657:North Carolina; D016544:Patient Simulation; D010808:Physical Examination; D011231:Preceptorship; D011320:Primary Health Care; D015397:Program Evaluation; D013337:Students, Medical; D013663:Teaching / Q000379:methods