MEDICAL-STUDENTS CONFIDENCE AND THE CHARACTERISTICS OF THEIR CLINICAL-EXPERIENCES IN A PRIMARY-CARE CLERKSHIP

Purpose. To investigate the relationship between medical students' con fidence and their experiences in caring for patients within a primary care clerkship, because hands-on experience is assumed to be positivel y related to the development of confidence (a subjective marker of com petence). Method. The participants were 60 students from the class of 1992 who completed a required third-year ambulatory care clerkship at the University of Kentucky Medical Center. The students documented the ir one-on-one experiences in patient care (under the supervision of pr eceptors in family practice, general pediatrics, or general internal m edicine) by completing data cards on each patient encounter. Also, for each encounter, the students used a Likert scale to rate their levels of confidence in dealing with the patient's primary diagnosis. The va riables recorded on the cards were then used to predict the students' levels of confidence during the encounters. The statistical analysis i ncluded descriptive statistics, Pearson correlations, and a stepwise m ultiple-regression procedure. Results. The mean number of patient enco unters per student was 99. The regression procedure selected three var iables from the data cards as significant independent predictors of th e students' confidence: management responsibility for the patient's pr oblem (R2 = .40), prior exposure to the patient's problem (R2 = .08), and performance of laboratory work during the patient encounter (R2 = .06). These variables were responsible for predicting 54% of the obser ved variance in the students' confidence (R2 = .54). Conclusion. Hands -on clinical experience was more important for building students' conf idence than any other encounter variable.