Outpatient setting is better learning environment

Medical students learn clinical urology more effectively in outpatient or clinic based settings than in inpatient or operative settings, according to a survey from Harvard Medical School.

The authors of the survey noted that time and resources spent on urology teaching in medical schools in the United States have been deteriorating during the past four decades. This is partly attributable to a shift in emphasis, the time available in the four year medical school curriculum, as well as the pressure on urologists to increase productivity at the expense of teaching. After the one week compulsory urology clinical rotation, 39 third year medical students were invited to gauge the amount learnt with regards to 13 urological topics and skills, and to document the number of patient encounters experienced per topic or skill. The students were randomised into two teaching groups: one group with predominantly outpatient clinics experience and the other group in inpatient or operative settings.

Almost two thirds of the students responded to the survey and students in the outpatient or clinic based settings were exposed to a greater number and breadth of patients with common urological problems. In particular, prostate cancer, benign prostatic hyperplasia, and erectile dysfunction, as well as prostate examination skills were better covered in the outpatient or clinic based environment. Students in the inpatient or operative setting reported fewer opportunities to perform pertinent physical examination skills, including male genitalia examination, compared with their outpatient or clinic based counterparts.

The authors recommended developing a validated means for assessing actual student learning in clinical urology to confirm their findings.