Abstract Title
Logbook analysis: an evaluation strategy for a new Internal Medicine clerkship

Authors

Chiesa
Daniela; Bollela
Valdes Roberto; Escalante
Rodrigo; Souza
Ruy Guilherme; Van Wyk
Jacqueline

Theme

Clinical

INSTITUTION

FAIMER-Brasil Regional Institute; University of Fortaleza
University of Kwazulu-Natal

Background

Logbooks are well known as student assessment tool, especially for auditing learning in clinical settings.

Summary of Work

Internal Medicine clerkship in a new medical school has been offered over a five month period:

  • one month in emergency department
  • three months in different general hospital’s wards
  • one month in Intensive Care Unit.

Logbook was introduced as a tool in the assessment's system.

University of Fortaleza clerkship assessment’s system:

  • work-based assessment;
  • MCQ test;
  • global rate scale;
  • logbook.

The aim of the study was to evaluate the quality of the students’ learning experience in the different settings after three  semesters of the clerkship implementation.

Quantitative analysis of 120 logbooks, 18 month-period  of clerkship implementation

  • most prevalent clinical cases
  • most prevalent procedures performed by students
  • comparision to proposed learning objectives for clerkship
Take-home Messages

Logbook is very well known tool for student assessment purpose (formative assessment). The findings suggest that logbook has also a strong potential as program evaluation tool, especially in clinical settings beyond the university boundaries.

Summary of Results

 

The most prevalent cases followed by students were: 

  • deep vein thrombosis; 
  • stroke; 
  • digestive tract diseases; 
  • pneumonia; 
  • diabetes mellitus and its complications; 
  • congestive heart failure; 
  • skin infections (cellulitis and erysipelas); 
  • sepsis and shock.

The students performed the following most common procedures: 

  • peripheral arterial puncture for blood gases analyses; 
  • peripheral and central venous access; 
  • tracheal intubation; 
  • paracentesis.

Some settings did not allow students a realistic opportunity to achieve the expected learning objectives.

Gaps in learning experience in: renal disease, endocrine disease (other than diabettes), rheumatologic diseases.

Students complained about lack of supervision in some settings.

These findings resulted in adjustments in rotations (included outpatient clinic) and increasing of preceptors in each ward to address the identified gaps.

Conclusion

Evaluation of the logbooks and formative feedback to students became a monthly event, thereby increasing the students’ opportunities to improve their learning experiences during the medicine clerkship and to allow adjustments, before the rotation ends.

References

Buckley S. et al. The educational effects of portfolios on undergraduate student learning: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11. Med Teach. 2009; 31(4):282-98.

Acknowledgement

Acknowledgements: Fabricio André Martins Costa; FAIMER 2012 Project Group (Elaian Amaral, Danette McKinley, Bruno Perotta, Ernesto Antônio Figueiró-Filho, Maria de Fátima Tazima, Silmar Gannam)

Support by University of Fortaleza

Background
Summary of Work

The logbooks from the four months rotation in a general hospital (three months in the wards and one month in the ICU) were analysed for this study.

This hospital is a public general hospital (medicine, general surgery, intensive care and pediatrics), that receives middle complexity patients from a tertiary hospital emergency department or an outpatient urgency unit. The hospital does not have emergency department. The university mantains an agreement with the hospital for funding the students activities. 

Each ward has 31 beds of a total of 155 patients (5 wards) in the Internal Medicine Unit. The Intensive Care Unit has 21 beds for clinical and surgical patients.

In each month, the hospital received 40 clerkship's students in Internal Medicine rotation.

There were five preceptors in each wards (they are hospital's employees), but only two of them were responsible for teaching. 

The teachers worked both in the hospital and in the university. There was one teacher in 2 of 5 wards.

Take-home Messages
Summary of Results

The students performed the following procedures (% of students):

 

The students cared patients with the following diseases (% of students):

The profile of the patients addimited at the hospital is the same as the most prevalent cases following by students.

The gaps with procedures were lumbar puncture and thoracocentesis.

Findings from this study resulted in adjustments and implementation of a ward rotation where students were placed in different units on a monthly basis. 

The criteria for minimum procedure were reviewed and redefined and clearly communicated to the students. University-based preceptors were allocated to each ward to facilitate clinical discussions. 

A part-time rotation through an outpatient clinic was included to address the identified gaps. 

The number of teachers and preceptors was improved (one teacher for each ward and three preceptors for each ward, that results in 2 students for each preceptor or teacher).

When students had a limited variety of cases, consisting mainly of chronic patients, they were allowed to swap wards with colleague to improve their learning by increasing their exposure to a greater variety of clinical cases. 



Conclusion
References
Acknowledgement
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