MEDICAL-STUDENTS CONFIDENCE AND THE CHARACTERISTICS OF THEIR CLINICAL-EXPERIENCES IN A PRIMARY-CARE CLERKSHIP

Purpose. To investigate the relationship between medical students' confidence and their experiences in caring for patients within a primary care clerkship, because hands-on experience is assumed to be positively related to the development of confidence (a subjective marker of competence). Method. The participants were 60 students from the class of 1992 who completed a required third-year ambulatory care clerkship at the University of Kentucky Medical Center. The students documented their one-on-one experiences in patient care (under the supervision of preceptors in family practice, general pediatrics, or general internal medicine) by completing data cards on each patient encounter. Also, for each encounter, the students used a Likert scale to rate their levels of confidence in dealing with the patient's primary diagnosis. The variables recorded on the cards were then used to predict the students' levels of confidence during the encounters. The statistical analysis included descriptive statistics, Pearson correlations, and a stepwise multiple-regression procedure. Results. The mean number of patient encounters per student was 99. The regression procedure selected three variables from the data cards as significant independent predictors of the students' confidence: management responsibility for the patient's problem (R2 = .40), prior exposure to the patient's problem (R2 = .08), and performance of laboratory work during the patient encounter (R2 = .06). These variables were responsible for predicting 54% of the observed variance in the students' confidence (R2 = .54). Conclusion. Hands-on clinical experience was more important for building students' confidence than any other encounter variable.