Clinical experience of medical students in primary care: use of an electronic log in monitoring experience and in guiding education in the Cambridge Community Based Clinical Course.

OBJECTIVES

The amount of medical student teaching in the community has increased markedly recently, but uncertainties remain about whether there is sufficient clinical material to meet students' learning needs and, if so, how best to monitor the experience and ensure that students are benefiting from it.

DESIGN

On the Cambridge Community Based Clinical Course, a 15-month attachment in primary care, the students used hand-held computers to monitor their clinical experience as it developed.

SETTING

The General Practice and Primary Care Research Unit, Cambridge, UK.

SUBJECTS

Medical students.

RESULTS

Thirteen students recorded 8140 contacts over 4 years. Contacts recorded by students over 15 months varied between 256 and 1153. Eight specialities each contributed more than 5% of total experience. These were general medicine, 26.9% (range 23.8%-36. 6%), obstetrics and gynaecology, 11.3% (range 7.2%-17.1%), orthopaedics and rheumatology, 11.3% (range 3.7%-15.2%), paediatrics, 10.7% (range 4.1%-19.8%), ENT, 7.4% (range 3.3%-10.2%), dermatology, 7.1% (range 4%-10.1%), psychiatry, 6.4% (range 5%-9.7%) and general surgery, 6.4% (range 1.1%-9.9%).

CONCLUSIONS

The results show that it is possible to get a broad and varied exposure to clinical problems on a long-term community-based course. However, as a consequence of the opportunistic way in which clinical experience is obtained on a community attachment, individual students often had gaps in their experience. The logs provided a means for identifying these gaps so that action could be taken to address them. The logs themselves proved to be a practical and feasible way to record student experience as it unfolded.