Abstract
Objective
To explore the use of web and palm digital assistant (PDA)-based patient logs to facilitate reflective learning in an ambulatory medicine clerkship.
Design
Thematic analysis of convenience sample of three successive rotations of medical students’ patient log entries.
Setting
Johns Hopkins University School of Medicine.
Participants
MS3 and MS4 students rotating through a required block ambulatory medicine clerkship.
Interventions
Students are required to enter patient encounters into a web-based log system during the clerkship. Patient-linked entries included an open text field entitled, “Learning Need.” Students were encouraged to use this field to enter goals for future study or teaching points related to the encounter.
Measurement and Main Results
The logs of 59 students were examined. These students entered 3,051 patient encounters, and 51 students entered 1,347 learning need entries (44.1% of encounters). The use of the “Learning Need” field was not correlated with MS year, gender or end-of-clerkship knowledge test performance. There were strong correlations between the use of diagnostic thinking comments and observations of therapeutic relationships (Pearson’s r=.42, p<0.001), and between diagnostic thinking and primary interpretation skills (Pearson’s r=.60, p<0.001), but not between diagnostic thinking and factual knowledge (Pearson’s r =.10, p=.46).
CONCLUSIONS
We found that when clerkship students were cued to reflect on each patient encounter with the electronic log system, student entries grouped into categories that suggested different levels of reflective thinking. Future efforts should explore the use of such entries to encourage and track habits of reflective practice in the clinical curriculum.
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Acknowledgments
The authors gratefully acknowledge the work of the Office of Academic Computing in developing the Patient Tracker software, and thank John Shatzer, Ph.D., for review and comment on an earlier version of this manuscript. Johns Hopkins University School of Medicine was the sole source of funding for this work.
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Thomas, P.A., Goldberg, H. Tracking Reflective Practice-Based Learning by Medical Students during an Ambulatory Clerkship. J GEN INTERN MED 22, 1583–1586 (2007). https://doi.org/10.1007/s11606-007-0315-0
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DOI: https://doi.org/10.1007/s11606-007-0315-0