Core clerkship in internal medicine at a rural community hospital in Israel

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Dear Editor

An increase in the number of medical students in Israel has resulted in a relative shortage of clinical teaching sites, a problem being faced in many jurisdictions around the world. It has been shown that the rural setting is adequate for teaching internal medicine¹. Yoseftal Hospital (YH)², a rural community hospital³ with 25 beds for medicine was chosen as a site for the internal medicine core clerkship. The hospital is located in a remote town of 40 000 inhabitants, 230 km from the closest tertiary medical center. Other sites were at the major university teaching hospital.

Groups of six self-selected students were allocated to take their 10 week clerkship in internal medicine at YH. The daily schedule allocated two students to the emergency department, and four participated in teaching rounds on the ward. In the afternoons, all students participated in tutorials. Each of the students was required to clerk 12 patients during the rotation. Case work-ups were submitted electronically to one of the authors (MA), graded and discussed with the student.

Evaluation of the students was performed with a personal questionnaire completed by the teachers at YH and at the university hospital, and graded on the American NBME Shelf examinations⁴. Evaluations were compared with those of students at the main university hospital (Table 1). P-values were calculated using a t-test for each year and for the total numbers of students. No significant differences were found (p=1) between YH students and those at main university sites.

Table 1: Comparison of students' test results and evaluations according to location of clerkship

Medical students at YH performed as well as those at the main campus, indicating that such an approach could resolve the problem of lack of clinical teaching locations in Israel.

Michael L Alkan MD¹, Tova Arad MD^2
1Ben Gurion University of the Negev, Beer Sheva
²Department of Medicine, Yoseftal Hospital, Eilat, Israel

References

1. Hansen L, Simanton E. Comparison of third-year student performance in a twelve-month longitudinal ambulatory program with performance in traditional clerkship curriculum. South Dakota Medicine 2009; 62(8): 315-317.

2. Clalit Mushlam. "Joseftal" Medical Center. (Online) 2010. Available: http://www.clalit-global.co.il/en/yoseftal_medical_center.html (Accessed 22 April 2013).

3. Worley P, Esterman A, Prideaux D. Cohort study of examination performance of undergraduate medical students learning in community settings. BMJ 2004; 328: 207. Available: http://www.bmj.com/content/328/7433/207

4. NBME. NBME home page. (Online) 2013. Available: http://www.nbme.org