Learning environment: The impact of clerkship location on instructional quality

Background and objectives: Students provide variable feedback on instructional quality at ambulatory training sites. We hypothesized several strengths and weaknesses of placing students at resident and non-resident training sites, including differences in faculty behaviors, patient characteristics, work environment, learning opportunities, and levels of student engagement. We systematically assessed for differences in learning quality between clerkship sites with and without residents. Methods: Students completed the MedED IQ, a validated survey assessing four domains of instructional quality, after completing a required primary care rotation. We calculated descriptive and summary statistics and two sample tests of proportion analyzing student agreement with each MedEd IQ item with respect to the presence or absence of resident learners. Results: Of 149 total, 113 (75.8%) students completed the MedEd IQ site survey. A greater percentage of students at resident training sites (25.8%) than at non-resident sites (7.3%) agreed with the statement "The opportunities were too diverse, preventing me from developing proficiency." A greater percentage of students at resident training sites (19.4%) than at non-resident sites (1.2%) agreed with the statement "The health care team was not supportive of my learning." There were no differences between sites with or without residents on 14 items measuring preceptor actions or seven items measuring student involvement. Conclusions: Ambulatory clerkship sites with and without residents provide comparable quality learning experiences and precepting. Students placed at resident training sites may be overwhelmed with diverse opportunities and have a less supportive learning environment than students placed at non-resident sites. Future research should evaluate the impact of health care team development programs designed to foster a more supportive training environment for medical students. Ways of aligning residency and medical student education goals within the training setting should be explored.