title: Acquisition of clinical competence: Added value of clerkship real-life contextual experience.
abstract: BACKGROUND
  Medical students' limited access to patients induces a shift of learning activities from clinical wards to classrooms.
  
  
  OBJECTIVE
  Identify clinical competencies specifically acquired during real-life contextual clerkship added to case-based tutorials, by a prospective, controlled study.
  
  
  METHODS
  Students entering our eight-week internal medicine (IM) clerkship attended paper case-based tutorials about 10 common presenting complaints and were assigned to an IM specialty ward. For each tutorial case, two groups of students were created: those assigned to a ward, the specialty of which was unrelated to the case (case-unrelated ward, CUW) and those assigned to a ward, the specialty of which was related to the case (case-related ward, CRW).
  
  
  RESULTS
  Forty-one students (30 CUW and 11 CRW) volunteered for the study. Both groups had similar previous experiences and pre-clerkship exam scores. The CRW students collected more relevant clinical information from the patient (69% vs. 55% of expected items, p=0.001) and elaborated charts of better quality (47% vs. 39% of expected items, p=0.05). Clinical-knowledge mean score was similar (70%) in both groups (p=0.92).
  
  
  CONCLUSIONS
  While paper-case tutorials did provide students with clinical knowledge, real contextual experience brought additional, specific competencies. This supports the preservation of clinical exposure with supervision and feedback.
authors.affiliation: Department of General Internal Medicine, Unit of Development and Research in Medical Education, Faculty of Medicine, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rudaz
authors.forename: Anne M
authors.initials: AM
authors.lastname: Gut
authors.forename: Martine
authors.initials: M
authors.lastname: Louis-Simonet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Nu V
authors.initials: NV
authors.lastname: Vu
authors.forename: Mathieu R
authors.initials: MR
authors.lastname: Nendaz
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D010361:Patients; D018794:Problem-Based Learning; D011446:Prospective Studies