title: The effect of resident duty-hours restrictions on internal medicine clerkship experiences: surveys of medical students and clerkship directors.
abstract: PHENOMENON: Medical students receive much of their inpatient teaching from residents who now experience restructured teaching services to accommodate the 2011 duty-hour regulations (DHR). The effect of DHR on medical student educational experiences is unknown. We examined medical students' and clerkship directors' perceptions of the effects of the 2011 DHR on internal medicine clerkship students' experiences with teaching, feedback and evaluation, and patient care.
  
  
  METHODS
  Students at 14 institutions responded to surveys after their medicine clerkship or subinternship. Students who completed their clerkship (n = 839) and subinternship (n = 228) March to June 2011 (pre-DHR historical controls) were compared to clerkship students (n = 895) and subinterns (n = 377) completing these rotations March to June 2012 (post-DHR). Z tests for proportions correcting for multiple comparisons were performed to assess attitude changes. The Clerkship Directors in Internal Medicine annual survey queried institutional members about the 2011 DHR just after implementation.
  
  
  RESULTS
  Survey response rates were 64% and 50% for clerkship students and 60% and 48% for subinterns in 2011 and 2012 respectively, and 82% (99/121) for clerkship directors. Post-DHR, more clerkship students agreed that attendings (p =.011) and interns (p =.044) provided effective teaching. Clerkship students (p =.013) and subinterns (p =.001) believed patient care became more fragmented. The percentage of holdover patients clerkship students (p =.001) and subinterns (p =.012) admitted increased. Clerkship directors perceived negative effects of DHR for students on all survey items. Most disagreed that interns (63.1%), residents (67.8%), or attendings (71.1%) had more time to teach. Most disagreed that students received more feedback from interns (56.0%) or residents (58.2%). Fifty-nine percent felt that students participated in more patient handoffs. INSIGHTS: Students perceive few adverse consequences of the 2011 DHR on their internal medicine experiences, whereas their clerkship director educators have negative perceptions. Future research should explore the impact of fragmented patient care on the student-patient relationship and students' clinical skills acquisition.
authors.affiliation: a Department of Medicine , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lapin
authors.forename: Eva
authors.initials: E
authors.lastname: Aagaard
authors.forename: Christy
authors.initials: C
authors.lastname: Boscardin
authors.forename: Meenakshy K
authors.initials: MK
authors.lastname: Aiyer
authors.forename: Danelle
authors.initials: D
authors.lastname: Cayea
authors.forename: Adam
authors.initials: A
authors.lastname: Cifu
authors.forename: Gretchen
authors.initials: G
authors.lastname: Diemer
authors.forename: Steven
authors.initials: S
authors.lastname: Durning
authors.forename: Michael
authors.initials: M
authors.lastname: Elnicki
authors.forename: Sara B
authors.initials: SB
authors.lastname: Fazio
authors.forename: Asra R
authors.initials: AR
authors.lastname: Khan
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Lang
authors.forename: Matthew
authors.initials: M
authors.lastname: Mintz
authors.forename: L James
authors.initials: LJ
authors.lastname: Nixon
authors.forename: Doug
authors.initials: D
authors.lastname: Paauw
authors.forename: Dario M
authors.initials: DM
authors.lastname: Torre
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010561:Personnel Staffing and Scheduling; D011795:Surveys and Questionnaires; D014481:United States
keywords: clinical training; duty-hours regulations; medical student education