JMIR Publications

ABSTRACT

Background:

Medical students are increasingly expected to perform medical practices under supervision during clinical clerkships. In Japan, a 2021 revision to the Medical Practitioners Act formally supported students’ active participation in supervised medical practice. However, in community-based and rural clerkships, students may still have limited opportunities to transition from observing clinical care to performing tasks themselves. Because community-based attending physicians (CAPs) often determine when and how students can participate in care, faculty development (FD) for CAPs may help expand students’ participation.

Objective:

This study examined whether students placed at clerkship sites with FD-trained CAPs performed a wider range of Model Core Curriculum–recommended medical practices than students placed at sites without FD-trained CAPs. We also analyzed students’ daily reflections to assess how medical practice-related learning appeared in their written accounts.

Methods:

We conducted an explanatory sequential mixed methods study involving 112 fifth-year medical students who completed 3-week community-based clinical clerkships. Students were placed at sites with FD-trained CAPs (FD group; n=34) or without FD-trained CAPs (non-FD group; n=78). Students recorded daily experiences of 50 Model Core Curriculum–recommended medical practices as performed, observed/simulated, or not performed. Student-performed practices were compared between groups. Daily reflection sheets were divided into textual units and deductively coded according to Model Core Curriculum learning objectives. Generative artificial intelligence (AI) was used as an auxiliary tool to support deductive coding; final coding decisions and interpretations were made by human researchers.

Results:

A total of 112 students were included (FD group, n=34; non-FD group, n=78). Students in the FD group performed more types of examination and non-invasive practices than those in the non-FD group (median 10 vs 5 of 23 practices; Mann-Whitney U test, P<.001; r=0.49). Treatment and invasive practices were numerically higher in the FD group but did not differ significantly (median 5.5 vs 4 of 27 practices; Mann-Whitney U test, P=.08; r=0.23). Reflection sheet analysis yielded 4097 textual units, of which 822 (20.1%) were coded as medical practice-related content. Medical practice-related reflection codes were most frequent in week 1 (non-FD group, 214/815, 26.3%; FD group, 94/424, 22.2%) and decreased thereafter. The groups differed substantially in placement contexts, including medically underserved placements (FD group, 33/34, 97.1%; non-FD group, 4/78, 5.1%) and home-visit service exposure (FD group, 29/34, 85.3%; non-FD group, 43/78, 55.1%).

Conclusions:

Students at clinical clerkship sites with FD-trained CAPs reported performing a wider range of examination and non-invasive practices, whereas treatment and invasive practices did not differ significantly. These findings indicate associations rather than causal effects because the groups differed in placement context and analyses relied on self-reported experience data. FD-trained supervision, together with site characteristics such as medically underserved placements and home-visit service exposure, may expand opportunities for lower-risk clinical practices.