What do students actually do on an internal medicine clerkship? A log diary study E Murray, 1 P Alderman, 1 W Coppola 1 , R Grol, 2 P Bouhuijs 3 & C van der Vleuten 3 Background There are limited data on the amount of time students spend on teaching and learning while on internal medicine clerkships, and existing data suggest a wide international variation. Community-based teach- ing of internal medicine is now widespread; but its strengths and weaknesses compared to traditional hospital based teaching are still unclear. Aim To determine the proportion of time students spend on different activities on an internal medicine clerkship, and to determine whether this differs in general practice and in hospital. In addition we aimed to determine students' views on the educational value and enjoyment of various activities. Methods Prospective completion of log diaries record- ing student activities. Each student was asked to com- plete the diary for two separate weeks of their internal medicine clerkship: one week of general practice-based teaching and one week of hospital-based teaching. Results The response rate was 68% (88/130). Students spent approximately 5á5 h per day on teaching and learning activities in both environments, with more time (50 min vs. 30 min, P  0á007) on unsupervised inter- action with patients in hospital than in general practice, and more time (53 min vs. 21 min, P <0á001) under- going assessment in general practice than in hospital. Standard deviations were wide, demonstrating the heterogeneous nature of the data. Students perceived supervised interaction with patients and teaching by doctors as the most educational activities in both envi- ronments, but found it even more educationally valuable and enjoyable in general practice than in hospital (mean score for educational value: 4á27 in general practice, 3á88 in hospital, P  0á048; mean score for enjoyment 4á13 in general practice, 3á66 in hospital, P  0á03). Conclusions Students greatly value interactions with patients, perceiving these as both educational and enjoyable. Curriculum planners must continue to place patient-based learning at the centre of undergraduate medical education. The heterogeneity of the data sug- gests that individual students have very different experiences, despite apparently similar timetables. Keywords Education, medical/*methods; clinical clerk- ships/*standards; family practice/education; students, medical/*standards; curriculum. Medical Education 2001;35:1101±1107 Introduction A consistent feature of the current developments in undergraduate medical education is the increase in teaching taking place in general practice. This shift of student learning from the traditional teaching hospital environment to general practice is being driven both by educational factors, and by changes in patterns of health care delivery. Given the importance of learning in an authentic environment, 1,2 i.e. an environment similar to the one where the skills and knowledge learned will be even- tually applied, there is a strong theoretical argument for ensuring that clinical skills teaching is done in a clinical environment. Traditionally, the clinical environment chosen has been a teaching hospital, but for the reasons detailed below, students are increasingly learning their clinical skills in general practice. Reform of the National Health Service in the UK has led to a massive shift of care from the secondary to the primary care sector. 3±5 This has resulted not only in fewer patients available for students to learn from, but also those that are available tend to be at the severe end 1 Department of Primary Care and Population Sciences, University College London, UK 2 Centre for Quality of Care Research (WOK), University of Nijme- gen/University of Maastricht, The Netherlands 3 Department of Educational Development and Research, University of Maastricht, The Netherlands Correspondence: E Murray, Department of Primary Care and Popula- tion Sciences, Royal Free and University College Medical School, University College London, Holborn Union Building, Highgate Hill, London N19 3UA, UK. Fax: 0207 2818004; E-mail: elizabeth. murray@pcps.ucl.ac.uk Research papers Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:1101±1107 1101