Surgical Education Expanding surgical clerkships to remote community sites: the success of the Washington, Wyoming, Alaska, Montana, and Idaho experience Roger P. Tatum, M.D.*, Aaron Jensen, M.D., M.Ed., Lorrie A. Langdale, M.D. Department of Surgery, University of Washington, School of Medicine, HCS1660, S. Columbian Way, s-112-gs, Seattle, WA 98108, USA Abstract BACKGROUND: The purpose of this analysis was to determine if the surgical clerkship model and site affect educational outcomes and student postclerkship perceptions. METHODS: Data from University of Washington students participating in surgical clerkships at traditional/academic or community/apprentice sites across Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) between 2005 and 2007 were gathered retrospectively. Comparisons of final examination scores as well as postclerkship student evaluations of the educational experience were made between traditional and community training sites. RESULTS: The mean final examination scores at WWAMI sites were significantly higher than those at traditional academic sites. Furthermore, WWAMI sites were rated higher with respect to time spent by faculty in direct observation, quality of the clerkship as a whole, and overall contribution to medical education. CONCLUSIONS: Community surgical clerkship sites remote from an academic institution can provide an excellent learning experience for students. © 2009 Elsevier Inc. All rights reserved. KEYWORDS: Medical student training; Education; Surgical clerkship; Community and rural sites The University of Washington School of Medicine (UWSOM) is a state medical school serving a 5-state region, which includes Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) (Fig. 1). This represents the largest geographic region in the United States for which there is only a single medical school. Each of the WWAMI states supports the medical school financially and contrib- utes a prescribed number of students to the entering class. This is a complex arrangement with implications for each year of medical education. Students spend their first pre- clinical year in their home state, joining their Seattle-based classmates at the UWSOM campus for the second year. Students strongly are encouraged to complete their basic third-year clinical clerkships in their home state. Fourth- year clerkship electives are available throughout the region and are open to all students. Beginning in 1993, the Department of Surgery at UWSOM began to send a proportion of students to WWAMI sites out- side of the Seattle area. These include Spokane, Washing- Author contributions were as follows: all authors contributed to the study design and analysis and interpretation of data; Dr Tatum was respon- sible for the acquisition of data and drafting of manuscript; Drs Jensen and Langdale were responsible for critical revision of the manuscript, and Dr Jensen was responsible for statistical expertise. Dr Tatum had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. * Corresponding author. Tel.: +1-206-764-2141; fax: +1-206-764- 2529. E-mail address: rtatum@u.washington.edu Manuscript received September 27, 2008; revised manuscript Novem- ber 21, 2008 0002-9610/$ - see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2008.11.035 The American Journal of Surgery (2009) 198, 436 – 441