Preparation for clinical practice: a survey of medical students' and graduates' perceptions of the effectiveness of their medical school curriculum

This paper describes the perceptions of students and graduates of the Hebrew University-Hadassah medical school in Israel regarding the effectiveness of their medical education in preparing them for work in the clinical setting. The six-year curriculum consists of three years of mainly lecture-based Basic Science courses, and three years of clinical education, consisting of clinical clerkship rotations of various lengths. An anonymous questionnaire containing 114 items was distributed to 294 students (in their clinical years) and 500 graduates of the faculty. A total of 371 respondents completed the questionnaire (response rate 49%). Overall 60% of the respondents were generally satisfied with the medical training they received. However, respondents indicated many deficiencies in the curriculum, and in their competences. More than half of the respondents felt that Basic Science courses lacked clinical relevance. Almost 40% of the respondents reported that students were not taught sufficient clinical skills in preparations for clinical practice. At least 50% of the respondents reported that they had not received adequate exposure to 26 out of the 36 important clinical activities and skills during clerkships. Only 33% of the respondents agreed that the fundamental knowledge, skills, attitudes and values that medical students should possess at the time of graduation were made explicitly clear to them. Perspectives of students and graduates were compared. In many questions significantly more graduates tended to rate their learning experience better than students. This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It also stresses the need to integrate better preclinical and clinical studies, and to change to active learning methods. This study demonstrates the necessity of gathering information from students and graduates to evaluate their medical education experience.