Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland 20814, USA.
Teach Learn Med. 2009 Oct;21(4):281-3. doi: 10.1080/10401330903228083.
The Liaison Committee on Medical Education (LCME) requires clinical clerkships in North American Medical Schools to define and monitor core problems and clinical conditions for medical students and adjust the clerkships to ensure that all students meet those objectives at all instructional sites. Clinical clerkships usually use medical student generated logbooks to meet these requirements. It is not clear what clinical clerkship directors are doing to meet these standards.
To determine how internal medicine clerkship directors develop problem lists, whether and how they verify student problem list entry, and how missed core problems are covered.
The Clerkship Directors in Internal Medicine (CDIM) organization conducts an annual survey of its institutional members (one member per medical school). In 2007, 75% of North American medical schools (82 of 110) responded to the survey, which included questions on core problem lists and medical student logbooks.
Ninety-four percent of responding medical schools had a core problem list for the core internal medicine clerkship. Most schools used an electronic logbook and verified student exposure to core problems (76%). The clerkship director usually did the verification (63%). Clerkships offered a variety of options to remedy lack of exposure to core problems and usually offered more than one option.
Clerkship directors in internal medicine develop, verify, and ensure exposure to core problems in internal medicine. Most clerkship directors used the CDIM recommended core problem list as a basis for their local core problem list. Emerging computer-assisted learning options may simplify clerkship adjustments for lack of exposure to core problems. It appears that clerkship directors are using logbooks appropriately to meet the LCME charge to monitor core problems and clinical conditions.
医学教育联络委员会（LCME）要求北美医学院的临床实习必须明确和监测医学生的核心问题和临床情况，并调整实习以确保所有学生在所有教学场所都能达到这些目标。临床实习通常使用医学生生成的日志来满足这些要求。目前尚不清楚临床实习主任为达到这些标准正在做些什么。
确定内科实习主任如何制定问题清单，他们是否以及如何验证学生的问题清单录入，以及如何弥补遗漏的核心问题。
内科实习主任组织（CDIM）对其机构成员（每所医学院一名成员）进行年度调查。2007 年，北美 110 所医学院中的 75%（82 所）对调查做出了回应，其中包括核心问题清单和医学生日志的问题。
94%的回应医学院都为核心内科实习制定了核心问题清单。大多数学校使用电子日志并验证学生对核心问题的接触（76%）。实习主任通常进行验证（63%）。实习提供了各种补救缺乏核心问题接触的选择，通常提供多种选择。
内科实习主任制定、验证和确保内科的核心问题接触。大多数内科实习主任以 CDIM 推荐的核心问题清单为基础制定当地的核心问题清单。新兴的计算机辅助学习选项可能会简化因缺乏核心问题接触而进行的实习调整。看来实习主任正在使用日志适当履行 LCME 的职责，以监测核心问题和临床情况。
