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      Comparison of Medical Students' Satisfaction with Family Medicine Clerkships between University Hospitals and Community Hospitals or Clinics

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          Abstract

          Background

          The purpose of this study was to compare students' awareness of and satisfaction with clerkships in family medicine between a university hospital and a community hospital or clinic.

          Methods

          Thirty-eight 4th year medical students who were undergoing a clerkship in family medicine in the 1st semester of 2012 were surveyed via questionnaire. The questionnaire was administered both before and after the clerkship.

          Results

          External clerkships were completed in eight family medicine clinics and two regional hospitals. At preclerkship, participants showed strong expectation for understanding primary care and recognition of the need for community clerkship, mean scores of 4.3±0.5 and 4.1±0.7, respectively. At post-clerkship, participants showed a significant increase in recognition of the need for community clerkship (4.7±0.5, P<0.001). The pre-clerkship recognition of differences in patient characteristics between university hospitals and community hospitals or clinics was 4.1±0.7; at post-clerkship, it was 3.9±0.7. Students' confidence in their ability to see a first-visit patient and their expectation of improved interviewing skills both significantly increased at post-clerkship (P<0.01). Satisfaction with feedback from preceptors and overall satisfaction with the clerkship also significantly increased, but only for the university hospital clerkship (P<0.01).

          Conclusion

          Students' post-clerkship satisfaction was uniformly high for both clerkships. At pre-clerkship, students were aware of the differences in patient characteristics between university hospitals and community hospitals or clinics, and this awareness did not change by the end of the clerkship.

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          Most cited references12

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          Does community-based education increase students' motivation to practice community health care? - a cross sectional study

          Background Community-based education has been introduced in many medical schools around the globe, but evaluation of instructional quality has remained a critical issue. Community-based education is an approach that aims to prepare students for future professional work at the community level. Instructional quality should be measured based on a program's outcomes. However, the association between learning activities and students' attitudes is unknown. The purpose of this study was to clarify what learning activities affect students' attitudes toward community health care. Methods From 2003 to 2009, self-administered pre- and post-questionnaire surveys were given to 693 fifth-year medical students taking a 2-week clinical clerkship. Main items measured were student attitudes, which were: "I think practicing community health care is worthwhile" ("worthwhile") and "I am confident about practicing community health care" ("confidence") using a visual analogue scale (0-100). Other items were gender, training setting, and learning activities. We analyzed the difference in attitudes before and after the clerkships by paired t test and the factors associated with a positive change in attitude by logistic regression analysis. Results Six hundred forty-five students (93.1%), 494 (76.6%) male and 151(23.4%) female, completed the pre- and post-questionnaires. The VAS scores of the students' attitudes for "worthwhile" and "confidence" after the clerkship were 80.2 ± 17.4 and 57.3 ± 20.1, respectively. Both of the scores increased after the clerkship. Using multivariate logistic regression analysis, "health education" was associated with a positive change for both attitudes of "worthwhile" (adjusted RR: 1.71, 95% CI: 1.10-2.66) and "confidence" (1.56, 1.08-2.25). Conclusions Community-based education motivates students to practice community health care. In addition, their motivation is increased by the health education activity. Participating in this activity probably produces a positive effect and improves the instructional quality of the program based on its outcomes.
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            Students' evaluations of teaching and learning experiences at community- and residency-based practices.

            Research has identified students' preferences for clinical sites and the clinical teaching behaviors of preceptors valued by students. This study investigated medical students' perceptions of preceptor teaching behaviors and student performance information at community- and residency-based sites. The sample was 594 third-year medical students who completed a 4-week rotation in family medicine at community- and residency-based sites. Students completed two evaluation instruments that addressed clinical experiences and perceptions of effective teaching by clinical preceptors. For the majority of items, no statistically significant differences were found between students' rating of preceptors at private practices and residency sites. Generally, the students rated both types of preceptors as favorable. Student clinical performance was rated higher at community sites. Overall, preceptor teaching behaviors at community practices and residency programs were rated favorably by students. Differences were noted between site types in their clinical evaluation of students.
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              What do medical students learn when they follow patients from hospital to community? A longitudinal qualitative study

              Context Although longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital. Methods The authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes. Results The most frequent theme was ‘chronic disease management’ (25%) followed by ‘patient-centred care’ (22%), ‘health care systems’ (20.9%), ‘biomedical issues’ (19.7%), ‘community services’ (9.5%) and ‘student’s role conflict’ (2.3%). There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3%) and health systems (18.2%) were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1%) and patient centredness (31.8%) were the dominant themes after the 10-month longitudinal follow-up. Conclusion Longitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.
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                Author and article information

                Journal
                Korean J Fam Med
                Korean J Fam Med
                KJFM
                Korean Journal of Family Medicine
                The Korean Academy of Family Medicine
                2005-6443
                2092-6715
                November 2016
                18 November 2016
                : 37
                : 6
                : 340-345
                Affiliations
                Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea.
                Author notes
                Corresponding Author: Eal Whan Park. Tel: +82-41-550-3997, ewpark@ 123456dku.edu
                Article
                10.4082/kjfm.2016.37.6.340
                5122666
                3cccec88-2cf2-4596-8ccf-d08db84ba922
                Copyright © 2016 The Korean Academy of Family Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 February 2016
                : 07 June 2016
                : 07 June 2016
                Categories
                Original Article

                Medicine
                medical students,clinical clerkship,primary health care,community medicine
                Medicine
                medical students, clinical clerkship, primary health care, community medicine

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