Length of Attending-Student and Resident-Student Interactions in the Inpatient Medicine Clerkship
Abstract
UNLABELLED: PHENOMENON: Changes in the medical education milieu have led away from the apprenticeship model resulting in shorter physician-student interactions. Faculty and student feedback suggests that supervisor/student interactions may now be more cursory with increasing numbers of supervisors per student, and shorter duration of interaction. This may affect both education and student assessment. APPROACH: We compared inpatient attending and resident daily schedules with those of 3rd- and 4th-year medical students rotating on medicine clerkships at Brigham and Women's Hospital during academic years 2009-11 to determine the number of days of overlap. We used evaluation forms to determine the extent of evaluator's self-reported knowledge of the student. FINDINGS: We correlated the daily schedules of 199 students and 204 resident and 187 attending physicians, which resulted in 558 resident-student pairings and 680 attending-student pairings over 2 years. During a 4-week block, students averaged 3.7 attending physicians (M = 4, range = 2-7), with 49.7% supervised by 4 or more. Attending-student overlap averaged 9 days (M = 9, range = 2-23), though 40% were 7 days or less. Students overlapped with an average 3.4 residents (M = 3, range = 1-6). Resident-student overlap averaged 12 days (M = 11, range = 3-26). There were 824 student assessment forms analyzed. Resident and attending physician supervisors describing knowledge of their student as "good/average" overlapped with students for 14 and 11 days respectively compared to resident and physician supervisors who described their knowledge as "poor" (11 days, p < .01; 6 days, p < .01). Insights: On the inpatient medicine clerkship, students have multiple supervising physicians with wide variability in the period of overlap. This leads to a disrupted apprenticeship model with fragmentation of supervision and concomitant effects on assessment, feedback, role modeling, and clerkship education.
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Trainees often interact with supervising physicians in short, fragmented rotations, limiting opportunities for meaningful coaching and trust-building.
“Trainees often interact with supervising physicians, in short, fragmented rotations, limiting opportunities for meaningful coaching and trust-building[24].”
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- Authors
- Osman, N. Y., Walling, J. L., Mitchell, V. G., & Alexander, E. K.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Osman, Nora Y.
- Venue
- Teaching and Learning in Medicine
- Publisher
- Informa UK Limited
- Published
- 2015-04-03
- Volume
- 27
- Issue
- 2
- Pages
- 130-137
- ISSN
- 1040-1334 (ISSN-L)
- 1532-8015
- OpenAlex
- W1971127284
- Cited by
- 16
- References
- 35
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 3 · 2021: 1 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 3
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Teaching and Learning in Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Health and Medical Education
- Keywords
- apprenticeship model, student assessment, feedback, role modeling, medical education
- MeSH terms
- Boston, Clinical Clerkship, Clinical Competence, Education, Medical, Undergraduate, Educational Measurement, Female, Humans, Internship and Residency, Interprofessional Relations, Male, Patient Care Team, Students, Medical, Time Factors, Workload
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