The "flipped visit": an innovative method to improve medical student self-efficacy through a structured approach in clinic.

Background: Specialty clinics can be challenging for students on the internal medicine clerkship. They often lack the specialized knowledge necessary to fully engage in the clinic and may be pushed into an observational role, rather than being afforded meaningful opportunities. These peripheral roles undermine self-efficacy, and, therefore, education and interest. We sought to improve self-efficacy of students attending non-malignant hematology clinic, as well as to enhance interest in hematology and internal medicine.

Methods: We developed a flipped visit model analogous to the flipped classroom. Students each received pre-readings accompanied and pre-assigned cases with delineated reasons for referral and learning objectives. This model allowed students to prepare the hematology content for visits prior to arrival and then focus their time in clinic on executing visits. Participating students completed pre- and post-clinic surveys. These surveys covered core concepts in self-efficacy and interest in hematology and internal medicine on a five-point Likert scale.

Results: Of 103 students attending hematology clinic, 38 students (37%) opted to participate. Two of the 38 did not complete the post-clinic survey. Students had a statistically significant increase in four of six measures of self-efficacy: evaluation of research relevant to patient care and practicing cost-effective care (p = 0.008 and 0.001, respectively); and creation of a differential diagnosis and treatment plan specific to hematology (both p < 0.001). While pre-clinic student responses expressed interest in more exposure to hematology or a possible career in hematology or internal medicine, this was not changed post-clinic. When comparing their experience to other clinics, 75% and 71% students rated hematology clinic slightly or much better than other medicine clinics and non-medicine clinics, respectively. The flipped visit improved self-efficacy both specific to hematology and more generally. While students rated the experience more highly than other clinics, there was no impact on career interest in hematology or internal medicine.

Conclusion: A flipped visit approach to incorporating medical students into hematology clinic that included pre-assigned cases and readings improved self-efficacy and was preferred by students. They may be adopted easily in other ambulatory education settings.