Purpose. Educators have begun to question whethei medical students are adequately prepared for the core clerkships. Inadequate preclerkship preparation may hinder learning and may be predictive of future achievement. This study assessed and compared the views of clerkship directors regarding student preparation for the core clinical clerkships in six key competencies. Method. In 2002, a national survey was conducted of 190 clerkship directors in internal medicine, family medicine, pediatrics, surgery, obstetrics/gynecology, and psychiatry from 32 U.S. medical schools. Clerkship directors were asked to report their views on the appropriate level of student preparation needed to begin the core clinical clerkships (none, minimal, intermediate, advanced), and the adequacy of that preparation (ranging from "much less" to "much more than necessary") in six key clinical competencies. Results. A total of 140 clerkship directors responded (74%). The majority reported that students need at least intermediate ability in five of six competencies: communication (96%), professionalism (96%), interviewing/physical examination (78%), life-cycle stages (57%), epidemiology/probabilistic thinking (56%), and systems of care (27%). Thirty to fifty percent of clerkship directors felt students are less prepared than necessary in the six competencies. Views were similar across all specialties and generally did not differ by other clerkship director characteristics. Conclusions. Almost half of clerkship directors were concerned that students do not receive adequate preparation in key competencies before starting the core clinical clerkships. Many medical schools may need to give more attention to the preclerkship preparation of students in these high-priority areas.
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