EDUCATION AND TRAINING Tracking Clerkship Experience: Just What Do Clinical Clerks See on an Elder Care Rotation? Laura L. Diachun, MEd, MD, à wz Lisa Van Bussel, MD, w§k Andrea Ens, BSc, w# Andrea C. Dumbrell, MA, w and Loretta M. Hillier, MA wÃà The Schulich School of Medicine, University of Western Ontario, Canada, has created a mandatory clerkship in El- der Care that consists of small group seminars, clinical ex- periences, and an Elder Care manual. This article describes the use of a paper-based log to track students’ clinical en- counters to determine whether the Elder Care clerkship of- fers students the opportunity for a broad range of clinical experiences to address curriculum objectives. Using a paper-based log that was completed after each clinical encounter, students recorded information including the reason for assessment, tests completed, care recommen- dations, and personal reflections. Each of 70 students com- pleted an average of 5.5 logs. Cognitive/psychiatric, medical, functional, and social problems were reported in more than 83% of the logs. Almost all students saw at least one patient with cognitive decline and one with depressive symptoms. Only six students reported seeing a patient with delirium. Students were able to think reflectively on their experiences. In matching the clerkship objectives to the learning modality(ies) in which they were addressed, it was found that knowledge-related objectives were supported primarily by seminars and manual content. Skills-related objectives were supported primarily by clinical experiences. The clinical experience logs used in this study provided evidence that, in the Elder Care clerkship, for the most part, students are seeing what we think they should be seeing. Study results have informed the revision of the logs, which will be an ongoing method of tracking objectives and stu- dents’ reflections and ensuring continuous quality improve- ment. J Am Geriatr Soc 55:1126–1133, 2007. Key words: geriatrics; medical education; curriculum objectives; reflective thinking T he increasing number of older persons requiring spe- cialized care and the lack of physicians with training to provide it challenges medical schools to do a better job of preparing medical students in the care of older adults. A national survey of current trends in geriatric training for general internal medicine students in the United States found that residents in some programs had little clinical experience with older patients, suggesting that they may not have had the opportunity to develop the skills needed to care for older people. 1 Similarly, in Canada few medical schools have mandatory clerkship rotations in geriatric medicine, and the number of hours of education devoted to geriatrics is limited. 2 In 2003, the Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada, requested that all 1-week clinical clerkships expand to 2 weeks in length. To ensure that medical students had the opportunity to learn about geriatrics, the Divisions of Geriatric Medicine and Geriatric Psychiatry developed a new mandatory 2-week clerkship in Elder Care. Limited faculty and compli- mentary curriculum led to the development of a combined Geriatric Medicine and Psychiatry Elder Care clerkship. The new Elder Care clerkship rotation focused on comprehensive psychogeriatric and geriatric assessment, emphasizing the evaluation, diagnosis, and management of delirium, depression, and dementia. The objectives of this third-year clerkship, which highlight evaluation of cogni- tive, psychiatric, medical, functional, and social domains, are consistent with those identified as core competencies for the care of older patients. 3 Key curriculum objectives in- clude ability to define geriatric psychiatric assessment and comprehensive geriatric assessment; to describe the diag- nostic criteria for dementia, depression, and delirium and the behavioral and psychiatric signs and symptoms of de- mentia; to administer and interpret a variety of commonly used assessment tools and to develop treatment plans ac- cordingly; and to recognize that the older people are indi- viduals and are a diverse population. In this clerkship, students participated in small-group seminars, attended geriatric clinics (e.g., general geriatrics, aging brain clinic, osteoporosis clinic, inpatient and out- reach geriatric mental health clinics, and geriatric emer- gency medicine) and attended on a geriatric psychiatry Address correspondence to Dr. Laura Diachun, Southwestern Ontario Regional Geriatric Program, St. Joseph’s Health Care London, 801 Commissioners Road East, London, ON, Canada N6C 5J1. E-mail: laura.diachun@sjhc.london.on.ca DOI: 10.1111/j.1532-5415.2007.01206.x From the Divisions of à Geriatric Medicine and § Geriatric Psychiatry, Faculty of Medicine, and # Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada; w Specialized Geriatric Services and k Regional Psychogeriatric Program, St. Joseph’s Health Care, London, Ontario, Canada; Ãà Aging, Rehabilitation and Geriatric Care Research Centre, z Lawson Health Research Institute, London, Ontario, Canada. JAGS 55:1126–1133, 2007 r 2007, Copyright the Authors Journal compilation r 2007, The American Geriatrics Society 0002-8614/07/$15.00