1. Longitudinal clerkship medical students:
the placement experience
what do they actually see and do?
Kathryn Weston, Sheree Lloyd,
David Garne, Nicky Hudson, John Bushnell
Graduate School of Medicine
University of Wollongong, NSW
Australia

2. Aim
To describe the clinical
experiences of a cohort of
longitudinal integrated
clerkship medical students
placed in regional, remote or
rural settings in Australia.
2

3. About the course…
• 4-year course
• Active engagement: “Tell me and I forget, teach me
and I remember, involve me and I learn.” Benjamin
Franklin 1706-1790
• Graduate entry
• Small cohorts 68 to 85 students per year
• Case-based learning approach

4. 4
12 month longitudinal
placement
Phase 3
Year 1 Year 2 Year 3 Year 4
Phase 1 Phase 2 Phase 4
Phase 3: Extended integrated
community placement in rural /
regional primary and hospital
care with electronic case based
learning core

5. 5
Phase 3
student clinical log entries
Year 1 Year 2 Year 3 Year 4

6. Analysis of clinical log entries
• 2010 cohort, entered Phase 3 in 2012 for 12
months
• 80 students recorded 50,866 clinical problems
using blueprint list of 92 core clinical
presentations
6

7. What students see and do during the course
60
50
40
30
20
10
0
Phase 1 Phase 2 Phase 3
Relative proportion obs/exam/hx
(percentage)
Observation
Examination
History taking

8. Phase 3 encounters

9. Demographics

10. Location of encounters in Phase 3
General practice
Hospital
Community/other
66;29;5%

11. Top 10 procedures in general practice (72%)
14
12
10
8
6
4
2
0
Percentage of procedures

12. Top 10 procedures in hospital (62%)
25
20
15
10
5
0
Percentage of procedures

13. Top 10 General practice presentations (32% of all)
Skin lump/lesion/ulcer
Joint pain/swelling
Preventative health & screening
Cough/haemoptysis
Patient with chronic disease
Skin rash/eruption
Tiredness
Limb pain/swelling
Depression/mood change
Fever

14. Top 10 Hospital presentations (33% of all)
Shortness of breath
Abdominal pain
Fever
Trauma/injuries
Vomiting/anorexia/nausea
Cough/haemoptysis
Limb pain/swelling
Joint pain/swelling
Chest pain
Patient with chronic disease

17. Complexity in encounters
50
45
40
35
30
25
20
15
10
5
0
1 2 3+
Percentage of records
Number of core presentations recorded per encounter

18. Complexity in addiction presentations
Addiction
Depression,
change in
Anxiety
Aggression,
violence &
abuse
133
4
Self-harm mood
11
21 21
35
18
47
6
11
3
15
3
2
6
9

19. Complexity with abnormal blood sugar

20. Complexity in chronic care
Depression and anxiety. …. It becomes impossible to
separate the obesity, chronic pain and depression from
one another and each likely contributes to the other. It
became difficult how to manage this patient; weight loss
would likely improve mood, but chronic pain and obesity
restricted her ability to lose weight which contributed to
her depression. …. Chronic care is an aspect of general
practice that I have found most difficult…

21. Conclusions
Medical students on an integrated clinical clerkship are :
• actively involved in patient care and have authentic
learning experiences
• exposed to a range of clinical problems and patients
with multiple problems
It will be useful to explore the impact of longitudinal
clerkship experience in junior doctor years