Promoting the development of doctoring competencies in clinical settings.

Background and Objectives: This UME-21 project was developed to promote a variety of clinical competencies during a 12-week medicine clerkship for third-year students. Methods: The clerkship is divided into three 4-week rotations-two inpatient rotations and one outpatient rotation. During each rotation, students select a competency, review the module about that competency on the clerkship Web site, and perform a literature search. Learning exercises prompt students to ask their preceptor to model and discuss the performance of the competency on at least one patient and to provide feedback on their performance at least twice. At the end of each rotation, students are required to write about what they learned from the articles they read, write a critical analysis of their performance of the competency on one patient, and complete an evaluation questionnaire. This report is based on the results from the students' evaluation questionnaire. Results: At the end of the first six rotations, 120 students completed 330 evaluations of the course (93% response rate). The most frequently selected competency modules were behavior modification and patient education. In 81.5% of the evaluations, students felt that there was at least moderate improvement in their ability to perform the selected competency during the rotation. By the end of the rotation, in 85.3% of the evaluations, students indicated that they were confident performing the competency most or almost all of the time. Observing the preceptor was the component of the curriculum most often rated as helpful (59.1%), followed by literature review (57.9%), reviewing the Web site module (45.2%), and observation and feedback by the preceptor (32.7%). Conclusions: Based on student reports, the approach described in this paper appears to be a promising way to teach important doctoring competencies in a clinical setting.