A comparison of family medicine and internal medicine experiences in a combined clerkship.

BACKGROUND

Learning experiences during the medical school clinical rotation are largely shaped by patient contacts in a variety of clinical settings. For this reason, it is important to learn as much as possible about whether learning goals are being met. The patient encounter log has been used as a program evaluation tool to track students' clinical experiences.

METHODS

In the present study, we used a scannable pencil and paper form to compare clinical and demographic data from two primary care experiences in a multidisciplinary clerkship. Students manually recorded the encounter date, patient age and gender, the students' level of involvement with the patient, and involvement with procedures. Up to four diagnoses relevant to the encounter were also recorded. To document the clinical content of the encounters, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9- CM) codes were used.

RESULTS

Differences in patient encounters were found in five of the most frequently logged ICD-9-CM categories and also the presence of multiple diagnostic categories. Fewer family medicine encounters could be categorized as observational than general internal medicine encounters, and students on the family medicine month conducted physical examinations more frequently. Lower patient age was recorded for family medicine patients seen. Patient gender was balanced and comparable for the two specialties. The majority of the most frequently logged ICD-9-CM categories were strikingly similar. The range of diagnoses logged was identical. Students also documented similar opportunities for first contact with patients, doing patient histories, and the lack of exposure to procedures.

CONCLUSIONS

Ambulatory family medicine and internal medicine experiences can be both reinforcing and complementary, resulting in a more complete view of primary care. Common exposures in some diagnoses, ie, hypertension, can illuminate subtle differences in how family physicians manage patients in contrast to general internists. Students benefit from "hearing it again" but also from seeing that different approaches can lead to beneficial effects for patients. Other diagnoses that students experience in family practice offices that differ from their internal medicine rotation and vice versa ensure that students experience both the breadth and depth of primary care.