Evaluation of an innovative pediatric clerkship structure using multiple outcome variables including career choice

Background: Few studies have examined alternative structures for inpatient clerkships. Objective: Compare 2 inpatient clerkship structures using multiple outcome variables. Design: Prospective, randomized controlled trial. Setting: Tertiary-care, freestanding children's hospital. Subjects: All medical students enrolled in the third-year pediatric clerkship in the 2001-2003 academic years. Intervention: A clerkship structure consisting of an academic attending, a third-year pediatric resident, and 4 third-year medical students, but no interns. Measurements: Student end-of-rotation examinations, evaluations, a questionnaire, and career choices were used to evaluate the intervention. Patient logs and resource utilization were also assessed. Statistical analysis included evaluating differences between groups and measuring effect size. Results: Two hundred and three students were randomized. Compared with those on the traditional services, students on the intervention service encountered more key diagnoses in the patients they cared for (4.4 vs. 3.6, P < .01). These students also gave higher ratings to their overall attitude (4.48 vs. 4.26, P = .02) and input into patient care decisions (4.45 vs. 3.98, P < .01). More than twice as many students on the intervention service matched in pediatrics (OR 2.52, 95% confidence interval 0.99-6.38). Multivariate analysis of length of stay and total charges for selected patients revealed similar outcomes. Conclusions: A third-year pediatric clerkship that focuses on students is associated with increased satisfaction, higher interest in pediatrics, and consistent resource utilization. The intervention, therefore, merits continuation, whereas further research is required to identify which aspects of the intervention are responsible for its positive effects.