As critical as clinical clerkships are to medical education, securing clerkships has
become increasingly difficult over the past decade
“It's a very competitive environment with more and more osteopathic schools, larger
allopathic classes, and competing for white coat space with other clinical programs,
whether it be physician's assistant programs, nurse practitioner programs. It's just
very, very competitive,” Feldstein said. “We could have a great relationship with
a hospital, and tomorrow it gets sold, or two years from now, it closes. And as more
and more care goes outpatient, we've got to adapt.”
Adjusting to the growth of outpatient care does present challenges, Becker said. In
years past, patients were often in the hospital longer giving students more time to
interact and learn with a patient. Now, Becker explained, discharge discussions begin
almost as soon as a patient is admitted.
“Certainly more and more of medicine is in the outpatient environment, and we have
to learn to be more and more comfortable with having our students get outpatient medical
education,” he said.
Technological advances are also impacting clinical clerkships.
“They've changed the way we do things,” Golden said. “We have electronic medical records
now. We have information at our fingertips. And so that puts us in a place where the
pace is much higher, much faster, and the time to diagnosis is shorter.”
What that means, Golden explained, is that expectations have changed. Basic clinical
skills that were once learned during clerkships are now expected to be mastered before
the clerkship even begins. Furthermore, the emphasis has shifted to more specialty-specific
skills.
“In the past we were happy to follow our preceptor around and learn everything about
anybody who walked in the door,” she said. “Now, we try to expose our students to
as much of a specialty as we can in each core rotation.”
These challenges, Golden added, are part of the evolution of medicine.
PCOM is responding to these challenges with innovative, online blended learning for
all the core rotations with online preceptors.
“Because hospital business is so fast-paced, there isn't that time where an attending
or a resident could stop for a half hour and give a lecture,” Becker said.
Online blended learning is designed to help students better prepare for exams, Becker
explained. Improved performance on the end of the clerkship exams (COMAT), as well
as the COMLEX Level 2CE Board exams, could enhance a student's chances of being selected
for residency interviews.