Objective: To evaluate the casemix seen during an internal medicine clerkship and to assess the educational value of the problems seen.
Design: A modified Delphi-group opinion technique was used to develop a clerk log that included priority problems for internal medicine. Over a 12-month period, clerks recorded their exposure to the problems seen during their eight-week rotations. General internists rated the importance of each of the problems on a three-point scale.
Setting: The inpatient internal medicine services in six university teaching hospitals.
Subjects: All clinical clerks in a single undergraduate year recorded their experiences. All university-based general internists participated in rating problem importance.
Measurements and main results: The final approved log contained 72 problems, 64 of which received importance ratings greater than or equal to 2 on the three-point scale. The frequency of clerk exposure per problem was high and the correlation between frequency of exposure and importance was good. Ten important problems had relatively low exposure and four problems of lower importance had high exposure.
Conclusions: The clinical clerks were exposed to a broad spectrum of diseases, but some key problems were not well represented on the wards. Alternative strategies, including increased ambulatory care exposure, will be required to complete the exposure and to assure that the quality of patient exposure matches the quantity.