ABSTRACT

This PhD study was carried out at The Unit of Medical Education, Aarhus University.

The overall aim of the study was to describe and analyze the clerkship as a training site for medical students. The field of study comprised surgical and internal medical clerkships in the 7 th /8 th semester (old/new curriculum). Two empirical studies were conducted: a field study and an interview study.

The field study included 38 days of participant observation of six medical students combined with interviews prior to and following the clerkships. Data from interviews and observations were analyzed qualitatively. The analysis revealed that students mainly learned by observation of doctors working. Doctors thereby mainly functioned as role models. Students were actively engaged in work tasks when they clerked patients in the internal medical ward or when assisting in the OR. The supervision of students who were observed was characterized by its lack of variation and by its didactic attributes. Focus remained on declarative rather than on procedural knowledge. Feedback to students was sparse and stimulation of students' reflection lacked. Students thereby received little help to make sense of their clinical experiences. Finally, students' motivation decreased along the course of the clerkship. The medical students were given freedom to choose among the learning opportunities offered throughout the clinical day. However, the consequence of freedom was lack of responsibility. Without responsibility, students were short of legitimacy and value to the community of practice - all adding up to the decrease in motivation. This study showed that clerkships offer a unique opportunity for medical students' access to gain insight into how doctors work, to physical signs and thereby perceptual knowledge, and to skills including cognitive skills. However, with learning being mainly observational and supervision being mostly didactic the learning potential of clerkship remains unexploited. Several new learning theories suggest that learning mainly takes place if students are allowed to actively construct knowledge by integrating new information and experiences into what they have previously come to understand, and if stimulated to reflect on experiences.

The interview study was a qualitative study based on individual interviews with eight selected clinical professors. They were strategically selected as "especially gifted supervisors". Taped interviews were transcribed and analyzed with the creation of typologies. The analysis showed that individual and unique characteristics overshadowed the amount of characteristics shared by the interviewed persons. They all represented separate views on learning, teaching, and knowledge. Thus, no best practice yielded from the study. However, the sum of perspectives on learning and teaching was remarkably identical with dominating and modern pedagogical theories. The study thereby suggests, that faculty development initiatives could add to a better exploitation of the learning potential in the clerkship.