Karen Schifferdecker - Academia.edu (original) (raw)
Papers by Karen Schifferdecker
Breast Cancer Research and Treatment
MedEdPORTAL Publications, 2008
Research on the risk of HIV/AIDS among youth in Africa has often focused on sexual behaviors, but... more Research on the risk of HIV/AIDS among youth in Africa has often focused on sexual behaviors, but does not describe the larger contexts in which they take place. In addition, much of the research frames youth sexuality in terms of problems and consequences, without exploring youth's constructions of sexuality. My research looks beyond reported sexual behaviors for HIV risk by examining the role of gender ideologies in shaping the sexuality of female and male youth in Dar es Salaam, Tanzania, and the connection of these ideologies to the larger contexts of their lives. Topics include an overview of the socio-economic features of Tanzania, a description of how adolescents become involved in sexual relationships, sexual behaviors within the context of these different relationships, and meanings attached to these relationships. Youth were trained to assist in the collection of in-depth interviews (N = 120), focus group discussions (N = 17), structured interviews (i.e., freelists, pi...
Health promotion practice, Jan 27, 2015
Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and met... more Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and methods, have successfully improved patient care delivery and outcomes. We adapted and tested the ALC model as a community-based obesity prevention intervention focused on physical activity and healthy eating. The intervention used QI tools (e.g., progress monitoring) and team-based activities and was implemented in three communities through nine monthly meetings. To assess process and outcomes, we used a longitudinal repeated-measures and mixed-methods triangulation approach with a quasi-experimental design including objective measures at three time points. Most of the 97 participants were female (85.4%), White (93.8%), and non-Hispanic/Latino (95.9%). Average age was 52 years; 28.0% had annual household income of $20,000 or less; and mean body mass index was 35. Through mixed-effects models, we found some physical activity outcomes improved. Other outcomes did not significantly change. Al...
Marginalization from decision-making processes mirrors the health disparities observed worldwide ... more Marginalization from decision-making processes mirrors the health disparities observed worldwide with respect to infrastructure investments, exposure to violence and environmental hazards, and rates of chronic disease. By enabling people to become change agents within their own communities, Participatory Action Research methods such as Photovoice can facilitate the co-creation of culturally relevant strategies to address the intersection of violence prevention and chronic disease prevention. The city of Manchester, NH, has implemented institutional policy changes to build cross-sector collaboration around issues of violence prevention, neighborhood revitalization, and active living. However, little is known about immigrant/refugee youth's perceptions of these issues. We conducted a Photovoice project to: 1) explore youth's perceptions of relationships between safety, active living, and healthy eating in the context of their daily lives; and 2) understand barriers/enablers of...
Over the past two years (2010-2012), community coalitions from a city and small-town in New Hamps... more Over the past two years (2010-2012), community coalitions from a city and small-town in New Hampshire (Manchester and Keene) and a rural town in Vermont (St. Johnsbury) are partnering with the Prevention Research Center at Dartmouth (PRCD) in an Action Learning Collaborative (ALC). The ALC model, adapted from the Institute for Health Care Improvement's Collaborative Model for Achieving Breakthough Improvement, was a platform for bringing academia and communities together to develop, implement, and study the CBPR process in health improvement efforts. The ALC uses an action-learning process in which community teams, with a shared aim, work together using quality improvement tools and methods to plan, implement and study community interventions. Project outputs from the ALC have included changes to workplace environments, increased understanding of urban neighborhood walkability and community organizing for health, and patient engagement tools aimed at hypertension prevention and ...
Background: This pilot study evaluates the ability of InSHAPE Together (IST), an innovative, mult... more Background: This pilot study evaluates the ability of InSHAPE Together (IST), an innovative, multilevel, intergenerational program, to promote physical activity and reduce sedentary behavior in three communities in New Hampshire and Vermont. Within a Community-Based Participatory Research process, communities adopted an Action Learning Collaborative (ALC) model to apply quality improvement tools to achieve participants' physical activity and nutrition goals. Methods: The ALC curriculum was designed with community leaders to encourage team learning, expand social supports, and frame individual goal-setting within the broader context of community health. IST was implemented in 9 monthly meetings by local project coordinators and content experts. Most of the 97 participants were female (85.4%), white (93.8%), and non-Hispanic/Latino (95.9%). Participant average age was 52 years (range 12-86). Baseline adult BMI was 35 and 28.0% had annual household income of $20,000 or less. Traine...
Workplace health promotion programs (WHPPs) require a multi-level approach to evaluate and monito... more Workplace health promotion programs (WHPPs) require a multi-level approach to evaluate and monitor progress in essential WHPP components shown to produce positive health and financial results. Evaluation tools exist to measure two essential WHPP components, environmental and policy factors, but these vary in depth and breadth. This presentation describes the background research, development and testing of an evaluation tool to measure environmental and policy factors in a multi-level, large organization. It begins with a brief review of existing tools and assesses their relevancy for large organizations and ability to monitor change over time. It then describes the development of a new tool based on two validated instruments and testing of the tool across the organization to assess if remodeling leads to a more comprehensive and applicable measure. Organizational response to the findings and applicability of the tool for similar WHPP programs will be shared to inform future testing ...
Informatics in primary care, 2008
Generalists in both the USA and UK have been at the forefront of improving information management... more Generalists in both the USA and UK have been at the forefront of improving information management skills, defined here as the abilities required to locate and utilise synthesised information for patient care that is accessible, current, relevant and valid. Over the past decade, a variety of interventions designed to improve knowledge and skills relative to information management has been implemented. The goals of training are for learners to demonstrate long-term retention of knowledge and skills gained and to be able to transfer this learning from the context of training into different situations and contexts, such as those encountered in the workplace. Thus, to conclude that learning has taken place, it is essential to study performance after learners have acquired knowledge and skills to see how well those have been retained and generalised. The current study builds on previous work conducted by the authors that described and evaluated an intervention designed to improve informat...
Family medicine, 2008
Training programs designed to improve information management have been implemented but not adequa... more Training programs designed to improve information management have been implemented but not adequately tested. Three critical components for information management were tested in a randomized control study: (1) knowledge of valid, synthesized summary information, (2) skills to use Web-based resources that provide access to these summaries, and (3) use of Web-based resources in clinical practice. Twenty-four primary care practices were provided with computers and high-speed Internet access and then matched, with half randomly assigned to receive training and half to receive training at a later date. Training was designed to address knowledge, skills, and use of Web-based information. Outcomes were assessed by comparing baseline and follow-up questionnaires that focused on five conceptual domains related to Web-based resource use for patient care decisions and patient education. Compared to the delayed training group, the initial training group increased their knowledge and skill of We...
Family medicine
Many schools rely upon community preceptors for office-based education of medical students. These... more Many schools rely upon community preceptors for office-based education of medical students. These preceptors struggle to balance clinical care with the learning needs of students. We aim to gain a deeper understanding of the teaching rewards and challenges of current community preceptors. Five schools' family medicine clerkship directors conducted in-depth interviews of two exemplary preceptors at each of their programs. Following qualitative analysis of the interviews, three directors conducted one focus group at their school. The individual and group interviews were recorded, transcribed, and analyzed using grounded theory. Exemplary community preceptors described strategies to improve the learning environment and specific teaching approaches. Well-known teaching strategies such as role modeling, adjusting instruction to the learner's needs, and selecting patients appropriate for a specific student were used. They also described newer techniques such as co-learning and int...
Quality Management in Health Care, 2008
Internet offers a significant information resource for health professionals. A strategy to improv... more Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice.
Medical Education, 2009
Mixed methods research involves the collection, analysis and integration of both qualitative and ... more Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available. The purpose of this paper is to remedy that situation by providing an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research. Mixed methods may prove superior in increasing the integrity and applicability of findings when studying new or complex initiatives and interactions in medical education research. They deserve an increased presence and recognition in medical education research.
Journal of Health Care for the Poor and Underserved, 2013
Although process elements that define community-based participatory research (CBPR) are well arti... more Although process elements that define community-based participatory research (CBPR) are well articulated and provide guidance for bringing together researchers and communities, additional models to implement CBPR are needed. One potential model for implementing and monitoring CBPR is Action Learning Collaboratives (ALCs); short term, team-based learning processes that are grounded in quality improvement. Since 2010, the Prevention Research Center at Dartmouth (PRCD) has used ALCs with three communities as a platform to design, implement and evaluate CBPR. The first ALC provided an opportunity for academia and community leadership to strengthen their relationships and knowledge of respective assets through design and evaluation of community-based QI projects. Building on this work, we jointly designed and are implementing a second ALC, a cross-community research project focused on obesity prevention in vulnerable populations. An enhanced community capacity now exists to support CBPR activities with a high degree of sophistication and decreased reliance on external facilitation.
Journal of Continuing Education in the Health Professions, 2012
Although there is increasing focus on provider behavior change as an outcome of continuing medica... more Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals (specific, measurable, attainable, realistic, and timely), a concept well supported as a strategy to promote behavior change. The goal of this study was to explore the relationship between SMART goals developed after attending a CME conference and subsequent provider behavior change, using the PLP as a tool. PLPs were used as the outcome measure for Dartmouth-Hitchcock Continuing Medical Education conferences conducted during the fall of 2010. Three months later, participants were asked how close they were to completing their goals. All participants' goals were analyzed according to SMART criteria. Of the 841 participants attending conferences in fall 2010, 347 completed a PLP. An independent t-test found that among the 125 participants who completed the follow-up survey, those who indicated that they had completed their goal or were "very close" or "extremely close" to completing their goal wrote SMARTer goals than those who reported being "not at all close" to "moderately close" to completing their goal (t = 2.48, df = 123, p = 0.015). Our results corroborate previous research that has found "use of specific strategies to implement research-based recommendations seems to be necessary to ensure that practices change." Future directions include both a study of use of a PLP compared to a simple intent to change document and work on helping participants to write SMARTer goals.
Academic Medicine, 2002
ABSTRACT Combining complementary clinical content into an integrated clerkship curriculum should ... more ABSTRACT Combining complementary clinical content into an integrated clerkship curriculum should enhance students' abilities to develop skills relevant to multiple disciplines, but how educational opportunities in primary care ambulatory settings complement each other is unknown. The authors conducted an observational analytic study to explore where opportunities exist to apply clinical skills during a 16-week integrated primary care clerkship (eight weeks of family medicine, four weeks of ambulatory pediatrics, and four weeks of ambulatory internal medicine). Using handheld computers, students recorded common problems, symptoms, and diagnoses they saw. The students also recorded information about the educational process of the clerkship. Two data files were created from the database. Descriptive statistics were used to characterize the students' clerkship experiences, and ANOVA was used to evaluate differences among these blocks within the clerkship. Students encountered different frequencies of presenting symptoms, the majority of which occurred in pediatrics (23.2 per student per week versus 16.3 in medicine and 16.8 in family medicine; p =.01). Students provided more behavioral change counseling in family medicine (5.2 episodes per student per week versus 4.2 and 2.0 in internal medicine and pediatrics, respectively; p =.01), and they performed more clinical procedures in family medicine (1.9 per student per week versus 0.6 and 1.1 in pediatrics and internal medicine, respectively; p =.001). Students were more likely to encounter specific conditions in internal medicine (35.3 per student per week versus 30.0 and 21.4 in family medicine and pediatrics, respectively; p =.01). Elements of the teaching and learning processes also differed by clerkship. Very little overlap was found in symptoms, conditions, procedures, and other educational opportunities in the ambulatory pediatrics, internal medicine, and family medicine blocks that constitute the integrated primary care clerkship. The blocks provided different and complementary learning opportunities for students. These findings will assist in clerkship planning and in guiding students to seek opportunities that will ensure educational excellence.
Breast Cancer Research and Treatment
MedEdPORTAL Publications, 2008
Research on the risk of HIV/AIDS among youth in Africa has often focused on sexual behaviors, but... more Research on the risk of HIV/AIDS among youth in Africa has often focused on sexual behaviors, but does not describe the larger contexts in which they take place. In addition, much of the research frames youth sexuality in terms of problems and consequences, without exploring youth's constructions of sexuality. My research looks beyond reported sexual behaviors for HIV risk by examining the role of gender ideologies in shaping the sexuality of female and male youth in Dar es Salaam, Tanzania, and the connection of these ideologies to the larger contexts of their lives. Topics include an overview of the socio-economic features of Tanzania, a description of how adolescents become involved in sexual relationships, sexual behaviors within the context of these different relationships, and meanings attached to these relationships. Youth were trained to assist in the collection of in-depth interviews (N = 120), focus group discussions (N = 17), structured interviews (i.e., freelists, pi...
Health promotion practice, Jan 27, 2015
Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and met... more Action Learning Collaboratives (ALCs), whereby teams apply quality improvement (QI) tools and methods, have successfully improved patient care delivery and outcomes. We adapted and tested the ALC model as a community-based obesity prevention intervention focused on physical activity and healthy eating. The intervention used QI tools (e.g., progress monitoring) and team-based activities and was implemented in three communities through nine monthly meetings. To assess process and outcomes, we used a longitudinal repeated-measures and mixed-methods triangulation approach with a quasi-experimental design including objective measures at three time points. Most of the 97 participants were female (85.4%), White (93.8%), and non-Hispanic/Latino (95.9%). Average age was 52 years; 28.0% had annual household income of $20,000 or less; and mean body mass index was 35. Through mixed-effects models, we found some physical activity outcomes improved. Other outcomes did not significantly change. Al...
Marginalization from decision-making processes mirrors the health disparities observed worldwide ... more Marginalization from decision-making processes mirrors the health disparities observed worldwide with respect to infrastructure investments, exposure to violence and environmental hazards, and rates of chronic disease. By enabling people to become change agents within their own communities, Participatory Action Research methods such as Photovoice can facilitate the co-creation of culturally relevant strategies to address the intersection of violence prevention and chronic disease prevention. The city of Manchester, NH, has implemented institutional policy changes to build cross-sector collaboration around issues of violence prevention, neighborhood revitalization, and active living. However, little is known about immigrant/refugee youth's perceptions of these issues. We conducted a Photovoice project to: 1) explore youth's perceptions of relationships between safety, active living, and healthy eating in the context of their daily lives; and 2) understand barriers/enablers of...
Over the past two years (2010-2012), community coalitions from a city and small-town in New Hamps... more Over the past two years (2010-2012), community coalitions from a city and small-town in New Hampshire (Manchester and Keene) and a rural town in Vermont (St. Johnsbury) are partnering with the Prevention Research Center at Dartmouth (PRCD) in an Action Learning Collaborative (ALC). The ALC model, adapted from the Institute for Health Care Improvement's Collaborative Model for Achieving Breakthough Improvement, was a platform for bringing academia and communities together to develop, implement, and study the CBPR process in health improvement efforts. The ALC uses an action-learning process in which community teams, with a shared aim, work together using quality improvement tools and methods to plan, implement and study community interventions. Project outputs from the ALC have included changes to workplace environments, increased understanding of urban neighborhood walkability and community organizing for health, and patient engagement tools aimed at hypertension prevention and ...
Background: This pilot study evaluates the ability of InSHAPE Together (IST), an innovative, mult... more Background: This pilot study evaluates the ability of InSHAPE Together (IST), an innovative, multilevel, intergenerational program, to promote physical activity and reduce sedentary behavior in three communities in New Hampshire and Vermont. Within a Community-Based Participatory Research process, communities adopted an Action Learning Collaborative (ALC) model to apply quality improvement tools to achieve participants' physical activity and nutrition goals. Methods: The ALC curriculum was designed with community leaders to encourage team learning, expand social supports, and frame individual goal-setting within the broader context of community health. IST was implemented in 9 monthly meetings by local project coordinators and content experts. Most of the 97 participants were female (85.4%), white (93.8%), and non-Hispanic/Latino (95.9%). Participant average age was 52 years (range 12-86). Baseline adult BMI was 35 and 28.0% had annual household income of $20,000 or less. Traine...
Workplace health promotion programs (WHPPs) require a multi-level approach to evaluate and monito... more Workplace health promotion programs (WHPPs) require a multi-level approach to evaluate and monitor progress in essential WHPP components shown to produce positive health and financial results. Evaluation tools exist to measure two essential WHPP components, environmental and policy factors, but these vary in depth and breadth. This presentation describes the background research, development and testing of an evaluation tool to measure environmental and policy factors in a multi-level, large organization. It begins with a brief review of existing tools and assesses their relevancy for large organizations and ability to monitor change over time. It then describes the development of a new tool based on two validated instruments and testing of the tool across the organization to assess if remodeling leads to a more comprehensive and applicable measure. Organizational response to the findings and applicability of the tool for similar WHPP programs will be shared to inform future testing ...
Informatics in primary care, 2008
Generalists in both the USA and UK have been at the forefront of improving information management... more Generalists in both the USA and UK have been at the forefront of improving information management skills, defined here as the abilities required to locate and utilise synthesised information for patient care that is accessible, current, relevant and valid. Over the past decade, a variety of interventions designed to improve knowledge and skills relative to information management has been implemented. The goals of training are for learners to demonstrate long-term retention of knowledge and skills gained and to be able to transfer this learning from the context of training into different situations and contexts, such as those encountered in the workplace. Thus, to conclude that learning has taken place, it is essential to study performance after learners have acquired knowledge and skills to see how well those have been retained and generalised. The current study builds on previous work conducted by the authors that described and evaluated an intervention designed to improve informat...
Family medicine, 2008
Training programs designed to improve information management have been implemented but not adequa... more Training programs designed to improve information management have been implemented but not adequately tested. Three critical components for information management were tested in a randomized control study: (1) knowledge of valid, synthesized summary information, (2) skills to use Web-based resources that provide access to these summaries, and (3) use of Web-based resources in clinical practice. Twenty-four primary care practices were provided with computers and high-speed Internet access and then matched, with half randomly assigned to receive training and half to receive training at a later date. Training was designed to address knowledge, skills, and use of Web-based information. Outcomes were assessed by comparing baseline and follow-up questionnaires that focused on five conceptual domains related to Web-based resource use for patient care decisions and patient education. Compared to the delayed training group, the initial training group increased their knowledge and skill of We...
Family medicine
Many schools rely upon community preceptors for office-based education of medical students. These... more Many schools rely upon community preceptors for office-based education of medical students. These preceptors struggle to balance clinical care with the learning needs of students. We aim to gain a deeper understanding of the teaching rewards and challenges of current community preceptors. Five schools' family medicine clerkship directors conducted in-depth interviews of two exemplary preceptors at each of their programs. Following qualitative analysis of the interviews, three directors conducted one focus group at their school. The individual and group interviews were recorded, transcribed, and analyzed using grounded theory. Exemplary community preceptors described strategies to improve the learning environment and specific teaching approaches. Well-known teaching strategies such as role modeling, adjusting instruction to the learner's needs, and selecting patients appropriate for a specific student were used. They also described newer techniques such as co-learning and int...
Quality Management in Health Care, 2008
Internet offers a significant information resource for health professionals. A strategy to improv... more Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice.
Medical Education, 2009
Mixed methods research involves the collection, analysis and integration of both qualitative and ... more Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available. The purpose of this paper is to remedy that situation by providing an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research. Mixed methods may prove superior in increasing the integrity and applicability of findings when studying new or complex initiatives and interactions in medical education research. They deserve an increased presence and recognition in medical education research.
Journal of Health Care for the Poor and Underserved, 2013
Although process elements that define community-based participatory research (CBPR) are well arti... more Although process elements that define community-based participatory research (CBPR) are well articulated and provide guidance for bringing together researchers and communities, additional models to implement CBPR are needed. One potential model for implementing and monitoring CBPR is Action Learning Collaboratives (ALCs); short term, team-based learning processes that are grounded in quality improvement. Since 2010, the Prevention Research Center at Dartmouth (PRCD) has used ALCs with three communities as a platform to design, implement and evaluate CBPR. The first ALC provided an opportunity for academia and community leadership to strengthen their relationships and knowledge of respective assets through design and evaluation of community-based QI projects. Building on this work, we jointly designed and are implementing a second ALC, a cross-community research project focused on obesity prevention in vulnerable populations. An enhanced community capacity now exists to support CBPR activities with a high degree of sophistication and decreased reliance on external facilitation.
Journal of Continuing Education in the Health Professions, 2012
Although there is increasing focus on provider behavior change as an outcome of continuing medica... more Although there is increasing focus on provider behavior change as an outcome of continuing medical education (CME), it has long been known that an increase in knowledge alone is rarely sufficient to induce such change. The Personal Learning Plan (PLP), designed to motivate and assess CME learning, was partly derived from SMART goals (specific, measurable, attainable, realistic, and timely), a concept well supported as a strategy to promote behavior change. The goal of this study was to explore the relationship between SMART goals developed after attending a CME conference and subsequent provider behavior change, using the PLP as a tool. PLPs were used as the outcome measure for Dartmouth-Hitchcock Continuing Medical Education conferences conducted during the fall of 2010. Three months later, participants were asked how close they were to completing their goals. All participants' goals were analyzed according to SMART criteria. Of the 841 participants attending conferences in fall 2010, 347 completed a PLP. An independent t-test found that among the 125 participants who completed the follow-up survey, those who indicated that they had completed their goal or were "very close" or "extremely close" to completing their goal wrote SMARTer goals than those who reported being "not at all close" to "moderately close" to completing their goal (t = 2.48, df = 123, p = 0.015). Our results corroborate previous research that has found "use of specific strategies to implement research-based recommendations seems to be necessary to ensure that practices change." Future directions include both a study of use of a PLP compared to a simple intent to change document and work on helping participants to write SMARTer goals.
Academic Medicine, 2002
ABSTRACT Combining complementary clinical content into an integrated clerkship curriculum should ... more ABSTRACT Combining complementary clinical content into an integrated clerkship curriculum should enhance students' abilities to develop skills relevant to multiple disciplines, but how educational opportunities in primary care ambulatory settings complement each other is unknown. The authors conducted an observational analytic study to explore where opportunities exist to apply clinical skills during a 16-week integrated primary care clerkship (eight weeks of family medicine, four weeks of ambulatory pediatrics, and four weeks of ambulatory internal medicine). Using handheld computers, students recorded common problems, symptoms, and diagnoses they saw. The students also recorded information about the educational process of the clerkship. Two data files were created from the database. Descriptive statistics were used to characterize the students' clerkship experiences, and ANOVA was used to evaluate differences among these blocks within the clerkship. Students encountered different frequencies of presenting symptoms, the majority of which occurred in pediatrics (23.2 per student per week versus 16.3 in medicine and 16.8 in family medicine; p =.01). Students provided more behavioral change counseling in family medicine (5.2 episodes per student per week versus 4.2 and 2.0 in internal medicine and pediatrics, respectively; p =.01), and they performed more clinical procedures in family medicine (1.9 per student per week versus 0.6 and 1.1 in pediatrics and internal medicine, respectively; p =.001). Students were more likely to encounter specific conditions in internal medicine (35.3 per student per week versus 30.0 and 21.4 in family medicine and pediatrics, respectively; p =.01). Elements of the teaching and learning processes also differed by clerkship. Very little overlap was found in symptoms, conditions, procedures, and other educational opportunities in the ambulatory pediatrics, internal medicine, and family medicine blocks that constitute the integrated primary care clerkship. The blocks provided different and complementary learning opportunities for students. These findings will assist in clerkship planning and in guiding students to seek opportunities that will ensure educational excellence.