Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital

Abstract

ObjectivesTo identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital.DesignA prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum.SettingAn Acute Medical Unit at a London teaching hospital.Outcomes(1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours.ResultsThere were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen.ConclusionsThere is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.

Supplementation: An Improved Approach to Question Based Collaborative Learning [Letter]

“…For example, Fung et al found that only 23.4% of acute presentations are admitted during normal working hours. 4 This means that more than 75% of acute cases are not encountered by medical students during regular placement hours which, therefore, cannot be incorporated into question making during QBCLs. Students may be deprived of the opportunity to create questions based on crucially important conditions, leading to large gaps in their knowledge and suboptimal performance in both examinations and their clinical career.…”

Supplementation: An Improved Approach to Question-Based Collaborative Learning [Response to Letter]

“…Students’ limited exposure to clinical presentations in-hours 2 highlights the need to increase scheduled out-of-hours and community-based placements (eg urgent care centres), rather than substituting real-life clinical exposure with pre-written case studies. Instead of relying predominantly on in-hours placement activities, perhaps medical students should have regular out-of-hours patient exposure to enhance their preparedness for practice.…”