Volume 198, Issue 5 , Pages e25-e27, May 2008
Seasonal variation in medical student experience in an obstetrics and gynecology clerkship
Article Outline
Objective
Our objective was to determine whether the medical student clinical experience varies during the academic year.
Study Design
Third-year medical students completing their obstetrics and gynecology clerkship were asked to complete a questionnaire about their clinical experience. The survey evaluated their experience with examinations and procedures using Likert-scale responses. The study was approved by the local institutional review board.
Results
A total of 90.5% of the students completed the questionnaire. Statistically more procedures were performed in the middle and late time periods than early in the year. This included the number of cervical examinations (P ≤ .001), speculum examinations (P ≤ .05), delivery of placentas (P ≤ .001) and partial delivery of infant with delivery of placenta (P ≤ .01), partial repair of an episiotomy (P ≤ .01), and number of ultrasounds (P ≤ .05) performed by the students.
Conclusion
For some obstetrical and gynecological procedures, student hands-on experience increased during mid- and late-year clerkship rotations.
Key words: experience, medical student, timing
Anecdotally, it is thought that medical students in clinical rotations at the beginning of the academic years (ie, July, August, and September) have less experience with hands-on procedures because new residents do most of the procedures during this time period. As the residents gain experience, medical students have more patient care responsibilities and are allowed to do more procedures such as deliveries and suturing.
Prior to undertaking the study, a Pub Med literature search on time of clerkship and student experience was performed. The few articles that studied timing of clerkship focused on academic performance. Baciewicz et al1 found that surgical clerkship written examination scores differed significantly by calendar block. Manley and Heiss,2 Whalen and Moses,3 and Reteguiz and et al4 found that board scores improved as the year progressed. Hampton et al5 reported higher final grades among obstetrics and gynecology and general surgery clerkship students with rotations later in the academic year. Our objective was to determine whether a true difference in clinical experience exists based on timing of the clerkship rotation.
Materials and Methods
We developed a questionnaire to assess student experience on the obstetrics and gynecology clerkship. Prior to starting the study, approval was obtained from the institutional review board. All students that rotated through the third-year obstetrics and gynecology clerkship during the 2004-2005 academic year were invited to complete the questionnaire, which consisted of 11 questions.
Two questions assessed the time and site of their clinical rotation. The survey evaluated the number of hands-on procedures completed during the rotation using scaled responses less than 5, 5-14, or 15 or more. Students reported the number of pelvic exams and vaginal deliveries participated in or performed; episiotomy repairs done; cesarean deliveries, tubal ligations, and gynecological surgeries they participated in; and the number of ultrasounds that they performed. For surgical cases in which they participated, an additional open-ended question was asked to assess whether they did any part of the operation other then cut suture, retract, or staple. Results were compared between early-year (July to October), midyear (November to February), and late-year (March to June) rotations. Using a Likert scale, 3 questions addressed the overall availability of procedures for the students, whether participation in patient care was appropriate for their level of training, and whether they felt that were given the opportunity to do procedures based on their level of training. A χ2 test or Fisher exact test was used for statistical analysis; P ≤.05 was considered significant.
Results
Two hundred medical students rotated through the obstetrics and gynecology clerkship during the study period; 90.5% completed the questionnaire. Statistically more students reported they performed a higher number of procedures in the middle and late time periods than early in the year. This was true for the number of cervical examinations (P ≤ .001), speculum examinations (P ≤ .05), delivery of placentas (P ≤ .001), partial delivery of infant with delivery of placenta (P ≤ .01), partial repair of an episiotomy (P ≤ .01), and number of ultrasounds (P ≤ .05) performed by the students. There was no difference in the number of complete deliveries, complete episiotomy repairs, participation in cesarean deliveries, tubal ligations, or gynecological surgeries between the time periods studied. (Table) There was no significant difference in how students felt about overall availability, their level of participation, or the opportunity to perform procedures between time periods. The mean score on the national board examination between early (July to October), mid (November to February), and late (March to June) rotations was not statistically different (P < .85).
TABLE. Medical student clinical experience
| Procedure | Procedures, # | Number of students | P value | ||
|---|---|---|---|---|---|
| July-October | November-February | March-June | |||
| Cervical examinations | Fewer than 5 | 9 | 7 | 6 | |
| 5-14 | 43 | 23 | 22 | ≤.001 | |
| 15 or more | 8 | 28 | 23 | ||
| Speculum examinations | Fewer than 5 | 9 | 7 | 4 | |
| 5-14 | 42 | 29 | 25 | ≤.05 | |
| 15 or more | 10 | 22 | 21 | ||
| Placenta delivery | Fewer than 5 | 15 | 10 | 11 | |
| 5-14 | 34 | 24 | 29 | ≤.001 | |
| 15 or more | 5 | 32 | 25 | ||
| Ultrasound | Fewer than 5 | 28 | 18 | 16 | |
| 5-14 | 17 | 17 | 17 | ≤.05 | |
| 15 or more | 11 | 27 | 22 | ||
| Complete delivery | Fewer than 5 | 31 | 28 | 14 | |
| 5-14 | 30 | 33 | 38 | ≤.1 | |
| 15 or more | 2 | 4 | 4 | ||
| Cesarean deliveriesa | Fewer than 5 | 13 | 7 | 4 | |
| 5-14 | 47 | 44 | 41 | ≤.1 | |
| 15 or more | 5 | 13 | 11 | ||
| Tubal ligationa | Fewer than 5 | 40 | 32 | 28 | |
| 5-14 | 20 | 29 | 25 | ≤1 | |
| 15 or more | 1 | 2 | 1 | ||
| Gynecologic surgeriesa | Fewer than 5 | 15 | 8 | 9 | |
| 5-14 | 21 | 23 | 34 | ≤1 | |
| 15 or more | 7 | 11 | 13 | ||
aStudent participation in surgical cases must be more than retraction, staple, or cut suture. |
Comment
Seasonal variation in student experience for some obstetrical and gynecologic procedures exists. For our study, data on the student's clinical experience were obtained through a questionnaire completed at the end of the clerkship, so recall bias could have affected the results. Even so, the students' responses indicate that they did more procedures and had a greater level of participation in patient care in the middle and late clerkship blocks.
At the time of the study, the students did their rotation at 1 of 3 different sites. One site was a county hospital with a large volume of obstetrical patients. The second site was a university hospital that had fewer deliveries but greater exposure to high-risk obstetrical patients and gynecological surgeries. The third site was a private community hospital that offered less volume but a good patient mix. We did not compare the clinical experience between sites because multiple studies have found no difference in student performance based on clerkship site such as university hospital, private hospital, or county hospital.1, 3, 6, 7
Our study shows that hands-on clinical experience increases with mid and late rotations in the third year. Chatenay et al8 revealed that in some situations higher volume of clinical experience translated to enhanced clinical skills based on better performance on objective structured clinical examinations. Our medical school requires that students take and pass a clinical skills examination at the end of their third year; however, we did not study whether timing of the clerkship correlated with higher practical examination scores. Another area of study would be exploring whether increased hands-on clinical experience affected the student's specialty choice.
References
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- . The effect on grades of the timing and site of third-year internal medicine clerkships. Acad Med. 1990;65:708–709
- . Clerkship timing and disparity in performance of racial-ethnic minorities in the medicine clerkship. J Natl Med Assoc. 2002;94:779–788
- . Order of rotation in third-year clerkships (Influence on academic performance). J Reprod Med. 1996;41:337–340
- . Clerkship site and duration: do they influence student performance?. Surgery. 1986;100:306–311
- . Uniform experience and assessment during a multisite surgical clerkship. Aust N A J Surg. 1994;64:506–511
- . Does volume of clinical experience affect performance of clinical clerks on surgery exit examinations?. Am J Surg. 1996;172:366–372
PII: S0002-9378(07)01192-1
doi:10.1016/j.ajog.2007.09.048
© 2008 Mosby, Inc. All rights reserved.
Volume 198, Issue 5 , Pages e25-e27, May 2008
