Clinical experience of medical students in primary care: use of an electronic log in monitoring experience and in guiding education in the Cambridge Community Based Clinical Course

OBJECTIVES: The amount of medical student teaching in the community has increased markedly recently, but uncertainties remain about whether there is sufficient clinical material to meet students' learning needs and, if so, how best to monitor the experience and ensure that students are benefiting from it. DESIGN: On the Cambridge Community Based Clinical Course, a 15-month attachment in primary care, the students used hand-held computers to monitor their clinical experience as it developed. SETTING: The General Practice and Primary Care Research Unit, Cambridge, UK. SUBJECTS: Medical students. RESULTS: Thirteen students recorded 8140 contacts over 4 years. Contacts recorded by students over 15 months varied between 256 and 1153. Eight specialities each contributed more than 5% of total experience. These were general medicine, 26.9% (range 23.8%-36. 6%), obstetrics and gynaecology, 11.3% (range 7.2%-17.1%), orthopaedics and rheumatology, 11.3% (range 3.7%-15.2%), paediatrics, 10.7% (range 4.1%-19.8%), ENT, 7.4% (range 3.3%-10.2%), dermatology, 7.1% (range 4%-10.1%), psychiatry, 6.4% (range 5%-9.7%) and general surgery, 6.4% (range 1.1%-9.9%). CONCLUSIONS: The results show that it is possible to get a broad and varied exposure to clinical problems on a long-term community-based course. However, as a consequence of the opportunistic way in which clinical experience is obtained on a community attachment, individual students often had gaps in their experience. The logs provided a means for identifying these gaps so that action could be taken to address them. The logs themselves proved to be a practical and feasible way to record student experience as it unfolded.