Meeting the demand of the future: a curriculum to stimulate interest in careers in primary care internal medicine.

BACKGROUND: There is a growing need for primary care physicians, but only a small percentage of graduating medical students enter careers in primary care. PURPOSE: To assess whether a Primary Care Intraclerkship within the Medicine clerkship can significantly improve students' attitudes by analyzing scores on pre- and post-tests. METHODS: Students on the Medicine clerkship at the University of Massachusetts Medical School participated in full-day 'intraclerkships',to demonstrate the importance of primary care and the management of chronic illness in various primary care settings. Pre-and post-tests containing students' self-reported, five-point Likert agreement scale evaluations to 26 items (measuring perceptions about the roles of primary care physicians in patient care and treatment) were collected before and after each session. Eleven intraclerkships with 383 students were held between June 2010 and June 2013. Responses were analyzed using the GLM Model Estimate. RESULTS: Results from the survey analysis showed significantly more positive attitudes toward primary care in the post-tests compared to the pre-tests. Students who were satisfied with their primary care physicians were significantly more likely to show an improvement in post-test attitudes toward primary care in the areas of physicians improving the quality of patient care, making a difference in overall patient health, finding primary care as an intellectually challenging field, and in needing to collaborate with specialists. Older students were more likely than younger students to show more favorable answers on questions concerning the relative value of primary care vs. specialty care. CONCLUSIONS: A curriculum in Primary Care Internal Medicine can provide a framework to positively influence students' attitudes toward the importance of primary care, and potentially to influence career decisions to enter careers in Primary Care Internal Medicine. Ensuring that medical students receive excellent primary care for themselves can also positively influence attitudes toward primary care.

Re-demonstration without remediation--a missed opportunity? A national survey of internal medicine clerkship directors.

BACKGROUND: Many different components factor into the final grade assigned for the internal medicine clerkship. Failure of one or more of these requires consideration of remedial measures. PURPOSE: To determine which assessment components are used to assign students a passing grade for the clerkship and what remediation measures are required when students do not pass a component. METHODS: A national cross-sectional survey of Clerkship Directors in Internal Medicine (CDIM) institutional members was conducted in April 2011. The survey included sections on remediation, grading practices, and demographics. The authors analyzed responses using descriptive and comparative statistics. RESULTS: Response rate was 73% (86/113). Medicine clerkships required students to pass the following components: clinical evaluations 83 (97%), NBME subject exam 76 (88%), written assignments 40 (46%), OSCE 35 (41%), in-house written exam 23 (27%), and mini-CEX 19 (22%). When students failed a component of the clerkship for the first time, 55 schools (64%) simply allowed students to make up the component, while only 16 (18%) allowed a simple make-up for a second failure. Additional ward time was required by 24 schools (28%) for a first-time failure of one component of the clerkship and by 49 (57%) for a second failure. The presence or absence of true remedial measures in a school was not associated with clerkship director academic rank, grading scheme, or percent of students who failed the clerkship in the previous year. CONCLUSIONS: Most schools required passing clinical evaluations and NBME subject exam components to pass the medicine clerkship, but there was variability in other requirements. Most schools allowed students to simply re-take the component for a first-time failure. This study raises the question of whether true remediation is being undertaken before students are asked to re-demonstrate competence in a failed area of the clerkship to be ready for the subinternship level.