INTERPRETIVE AND PROCEDURAL SKILLS OF THE INTERNAL-MEDICINE CLERKSHIP- PERFORMANCE AND SUPERVISION

This descriptive study prospectively examined the performance and supe rvision of interpretive and procedural skills during an internal medic ine clerkship. Students (N = 150) documented having done 7 required an d 12 elective skills. Preceptors of required skills were interns (44%) , residents (29%), attending physicians (12%), and others (16%). The e lective procedures and the percentage of students doing them were as f ollows: skin tests, 78%; nasogastric tube insertion, 57%; paracentesis , 44%; bone marrow sampling, 35%; lumbar puncture, 34%; thoracentesis, 34%; Papanicolaou smear, 29%; central line placement, 27%; cardiovers ion, 13%; bladder catheter insertion, 11%; arthrocentesis, 9%; and ski n biopsy, 7%. Elective procedures per student ranged from 0 to 9 (mean = 4) and were done less often in the first clerkship group than later in the academic year. Preceptors of electives were interns (46%), res idents (39%), and attending physicians (9%). House staff were more lik ely and faculty less likely to precept electives than required procedu res. Students' exposures to these skills are unequal. Their preceptors are generally house staff. To prepare medical students for postgradua te training, technical skills should be specifically addressed in the curriculum.