Integrating medical students' goals, self-assessment and preceptor feedback in an ambulatory clerkship.

BACKGROUND: Self-assessment and feedback are important elements for improving performance. However, coordinating their content remains elusive. PURPOSE: The purpose is to determine whether student self-assessment and preceptor feedback correlate with course outcomes and whether preceptor feedback informs student self-assessment. METHODS: Our students generate initial and midterm goals and preceptors provide midterm feedback. We coded goals and feedback as clinical subsets, knowledge, career oriented, and attitudinal. We assessed associations with exams and evaluations using correlations, chi-square, and comparisons of means. RESULTS: Students usually listed clinical goals (72%), whereas preceptors noted attitudes (50%). Students' self-assessments had little association with exams, evaluations, or preceptor feedback. Students cited by preceptors for clinical strengths scored higher on exams (77.2 vs. 72.7, p < .01). Those cited for knowledge received more honors and high pass (78 vs. 60%, p = .05) evaluations. CONCLUSIONS: Students and preceptors emphasize different aspects of performance. Student self-assessments were not associated with outcomes, but preceptor feedback was. Student self-assessment seemed resistant to feedback.

Associations between medical student log data and clerkship learning outcomes.

BACKGROUND: Largely due to regulatory requirements, medical students increasingly document patient encounters in logs. Prior studies demonstrated value in achieving course objectives but not regarding objective learning outcomes. PURPOSE: The purpose of this article is to assess the associations between students' log data and clerkship outcomes. METHODS: We assessed ambulatory, internal medicine-pediatrics clerkship logs. Students recorded patients' diagnoses, preceptor's teaching content and performing histories and physicals (H&P). We examined associations between log data and National Board of Medical Examiners Subject Exams (NBME), Objective Structured Clinical Exams (OSCE), and clinical evaluations. RESULTS: All 272 students completed logs (M diagnoses = 146.5, SD = 24.9). In univariate analysis number of diagnoses, preceptors' teaching patient management and performing H&P independently correlated with OSCE scores (r = .13-.24, p < .05). NBME scores correlated with diagnoses, performing H&P independently (r = .13-.18, p < .05). Teaching patient management, diagnoses, performing H&P independently were associated with clinical evaluations (all ps < .05). Regressions demonstrated that performing physicals independently was associated with NBME and OSCE scores (p < .05, R (2) = .03 and .05, respectively). Teaching disease management and pediatric diagnoses were associated with clinical evaluations (p < .05) in medicine and pediatrics, respectively. CONCLUSIONS: Aspects of teaching, increased clinical involvement, and student autonomy were associated with clerkship performance.