title: Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation.
abstract: BACKGROUND
  While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met "by random opportunity".((1)) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity.
  
  
  METHODS
  Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings' case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings' teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital.
  
  
  RESULTS
  The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met.
  
  
  CONCLUSIONS
  More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity.
authors.affiliation: Department of Medicine, The University of Western Ontario, London, ON; ; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; ; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Laura
authors.initials: L
authors.lastname: Diachun
authors.affiliation: Obermann Center for Advanced Studies, University of Iowa, University of Iowa, Iowa City, IA, USA;
authors.forename: Andrea
authors.initials: A
authors.lastname: Charise
authors.affiliation: Department of Medicine, The University of Western Ontario, London, ON; ; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; ; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Mark
authors.initials: M
authors.lastname: Goldszmidt
authors.affiliation: Department of Medicine, The University of Western Ontario, London, ON; ; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; ; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Yin
authors.initials: Y
authors.lastname: Hui
authors.affiliation: Department of Medicine, The University of Western Ontario, London, ON; ; Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON; ; Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
keywords: clinical clerkship; core competencies; curriculum-by-random-opportunity; geriatrics