Survey on Medical Students' Attitudes Toward Medical Practice Just Before Clinical Clerkship in Japan

Abstract

Introduction: The present study examined the confidence in essential medical practices during clinical clerkship (CC) and performance in preparing education for medical students who are just starting CC at our university.

Methods: We conducted a survey using questionnaires with 105 fourth-year medical students just before starting CC. This questionnaire analysis consists of the confidence in objective structured clinical examination (OSCE) and computer-based testing (CBT) performance toward essential medical practice recommended in the "Report on Medical Practice during Clinical Clerkship" by the Japanese Ministry of Health, Labor, and Welfare and medical safety for CC.

Results: The response rate was 67.6% (71/105). As for the performance in each OSCE theme, the confidence in basic clinical technique was significantly smaller compared to chest or abdominal examination, medical interview, and emergency response (p<0.05 each). Medical interviews showed stronger confidence compared to gynecological, breast, or rectal examinations and prostate palpitation among medical examinations (p<0.05 each). In the basic technique during CC, skin disinfection showed stronger confidence compared to other techniques (p<0.05 each). On surgical technique during CC, surgical hand washing and gown technique significantly showed stronger confidence compared to skin suture, suture removal, bleeding control, and surgical assistant (p<0.05 each).

Conclusion: Our results suggest that medical students just before CC have less confidence in invasive medical practice during CC. As medical practice by student doctors becomes public, further systematic basic skill training both before and during CC is warranted.

Keywords: clinical clerkship; confidence; medical practice; medical student; objective structured clinical examination.

Figure 1. Curriculum course in our university and questionnaire timing on this survey

Image Credit: Nobuyasu Komasawa

Figure 2. Box-and-whisker plot (median, interquartile range, and range) of subjective confidence in accomplishment on objective structured clinical examination (OSCE) and computer-based testing (CBT) in medical students using the visual analog scale (VAS), which ranged from 0 mm (extremely unconfident) to 100 mm (extremely confident)

*p<0.05 was considered statistically significant Image Credit: Nobuyasu Komasawa

Figure 3. Box-and-whisker plot (median, interquartile range, and range) of subjective confidence in the eight themes of objective structured clinical examination (OSCE) in medical students using the visual analog scale (VAS), which ranged from 0 mm (extremely unconfident) to 100 mm (extremely confident)

*p<0.05 was considered statistically significant between the groups Image Credit: Nobuyasu Komasawa

Figure 4. Box-and-whisker plot (median, interquartile range, and range) of subjective confidence in essential medical practices for clinical clerkship (CC) recommended by the "Report on Medical Practice During Clinical Clerkship" using the visual analog scale (VAS), which ranged from 0 mm (extremely unconfident) to 100 mm (extremely confident). (a) Medical examination, (b) general technique, (c) surgical technique, (d) laboratory examination, (e) emergency response, and (f) treatment

*p<0.05 was considered statistically significant between the groups Image Credit: Nobuyasu Komasawa

Figure 5. Box-and-whisker plot (median, interquartile range, and range) of subjective confidence in medical safety (patient safety, infection control, information management) using the visual analog scale (VAS), which ranged from 0 mm (extremely unconfident) to 100 mm (extremely confident)

Image Credit: Nobuyasu Komasawa