CLINICAL CLERKSHIPS IN NEUROSURGERY AND NEUROLOGY AT UNITED-STATES MEDICAL-SCHOOLS

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship; however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to take a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty. For the 13 medical schools with the two clerkships linked as alternatives, there was a larger ratio of neurosurgery to neurology students than in schools that did not link the two clerkships. For the seven schools with combined clerkships, the average time spent on either service and especially that spent on neurosurgery was decreased relative to schools in which required clerkships were not combined. Externships were much more common at schools with a residency training program in that specialty than in those without. Some potentially generalizable features of clinical clerkships are recorded.