Medical education comprises three major parts: basic science, clinical science, and clinical clerkship¹⁾. The clinical clerkship course focuses on competencies in real clinical settings, including clinical reasoning based on targeted history taking and physical examinations, performing clinical skills, and showing cooperative attitudes, whereas basic and clinical medicine courses focus on knowledge^2,3). Competency-based medical education (CBME) emphasizes the importance of students possessing knowledge of learning materials and demonstrating the ability to apply this knowledge in practice. In alignment with the CBME principles, the significance of clinical clerkship is continually underscored⁴⁾. Accordingly, the Institute for Korean Medical Education and Evaluation (IKMEE) mandates that a minimum of 1,200 hours of clinical clerkship be provided to educate Doctor of Korean medicine⁵⁾.

Clinical clerkship includes practical training in real-world settings under the supervision of skilled professionals who provide rich learning experiences. Additionally, students learn various practical skills and attitudes necessary for actual medical practice, and gain understanding of the structure and processes of healthcare. However, clinical clerkship faces several challenges. Student engagement in real practice is often insufficient, and learning materials cannot be controlled owing to the unpredictable nature of patient cases, such as the variability of patients presenting on any given day^6,7). Therefore, to expand the duration of clinical clerkships and develop a more robust clinical clerkship curriculum, it is necessary to analyze the current state of clinical clerkship courses and identify directions for improvement.

Previous research on clinical clerkships in Korean medicine education has focused on satisfaction with clinical clerkship education and specific departmental educational programs⁸⁾. Satisfaction with a clinical clerkship is significantly influenced by various factors, including the practice environment, quality of education, and the alignment between theoretical knowledge and practical experience. Furthermore, a positive correlation between professional self-concept and satisfaction with clinical clerkship has been highlighted, emphasizing the importance of practical hands-on experience in developing student professional identities⁹⁾.

Additionally, barriers to effective clinical education, such as discrepancies between classroom learning and real-world clinical practice, have been identified. This gap can cause psychological and physical discomfort among students, thereby hindering their learning abilities. Integrating realistic clinical contexts and addressing the dilemmas faced in clinical settings can, therefore, enhance the learning experience¹⁰⁾.

We therefore aimed to conduct a needs analysis among faculty members regarding various aspects of clinical clerkship education in a school of Korean medicine. The current status of clinical clerkship programs, faculty assessments of intended outcomes and student competencies in clinical clerkship, and requirements for improving clinical clerkship programs were analyzed to provide foundational data for future curriculum design.

A total of 20 professors (80% of the clinical professors) responded.

An online survey was conducted to identify the status of clinical clerkships and professor demands for improving clinical clerkship programs. The survey revealed the composition of clinical clerkships, student assessment methods, the importance and competency of each learning objective, and the need to expand and enrich clerkships.

Regarding the analysis of the composition of clinical clerkship, “observation of outpatient clinics” and “assisting clinical skills” were reported as the most common methods, while “student medical interview” was the lowest (2.6%), followed by “medical record writing” (6.1%) and “simulated practices” (7.8%). A study conducted in 2007 in Korea revealed that outpatient department (OPD) observations were 15.74% and 12.4% for observation and support in the operating room, respectively. In this study, the involvement of students in direct medical activities such as student pre-examinations or medical record documentation was found to be low at 5.2% and 4.3%, respectively¹²⁾. Observation of OPD allows students to experience diverse diseases, but might not be sufficient to train clinical reasoning. To enhance student clinical reasoning skills, it is essential to assign specific patients to students, allowing them to practice clinical reasoning and receive immediate feedback from professors and residents. Assisting clinical skills may allow students to observe and indirectly experience various situations and related techniques, but still has limitations in training student clinical skills; assisting in procedures offers the advantage of allowing students to experience a variety of procedural cases directly. However, if this assistance primarily involves observation, it may be insufficient to develop the skills required to perform the procedures independently. There have been significant restrictions on student clinical skills with actual patients, especially in interventions. In addition, students may be hesitant to perform physical examinations and other procedures because of a lack of confidence and insufficient practical training, leading to reliance on observation rather than active participation¹³⁾. To compensate for this problem, it is necessary not only to complete simple clinical skill education before clinical clerkship, but also to assess and supply feedback on students’ clinical skills so that students can engage in real practice. Comprehensive training and feedback, using models and simulators, are useful alternatives. Procedures for real patients often focus on physical examinations; these can be challenging to perform frequently because of issues such as patient autonomy, fatigue from repeated examinations, or discomfort, all of which can compromise patient safety. To expand the scope of education involving real patients, continuous efforts are required to improve patient awareness and guidance in teaching hospitals and to enhance preprocedural training for students (e.g., using simulators, role play, and CPX). The low engagement of students in the participatory clinical training methods in this study, including student medical interviews and medical record writing, necessitated further expansion. To address this issue, a dedicated student participation training program, such as a student internship program, can be established following mandatory clinical practice¹⁴⁾.

Regarding the assessments, although there was a high rate of positive responses concerning reliability and appropriateness (75% and 85%, respectively), it was essential to compare these findings with students’ opinions. If there is a discrepancy in student perceptions, the evaluation criteria and results should be compared more effectively. Four professors did not conduct clinical skill assessments. This outcome likely arose because the responses were collected per professor rather than by the clinical department, leading those not directly responsible for skill training to respond with “none.” Additionally, non-procedural skills such as communication skills and simulated medical record writing are sometimes classified as attitudes or knowledge rather than skills. For the systematic education and assessment of clinical skills, it is crucial to identify a list of essential clinical procedures corresponding to learning objectives and ensure their integration into both education and assessment. In nursing colleges, core nursing skills are categorized and managed separately for education and evaluation¹⁵⁾.

In the IPA analysis, areas where importance was high, but student performance was low, included acquisition of clinical procedures, clinical reasoning, and decision-making. These areas often involve higher-order thinking and practical procedural implementation, which are the focus of current medical practical examinations. Thus, it is imperative to strengthen the education and evaluation of advanced clinical reasoning and decision-making skills¹⁶⁾. In clinical clerkships, developing clinical reasoning and decision-making skills is closely related to obtaining essential information from patients within a limited timeframe. To facilitate genuine learning beyond mere observation, a more structured approach, such as task-based education, is necessary. Throughout the entire clinical clerkship, a standardized framework should be adopted to ensure uniform and comprehensive education on essential clinical presentations, with evaluations conducted consistently over the course of training ^17,18). Students should practice differential diagnosis including history taking, physical examination, and related clinical skills based on the chief complaints of the patient, integrating theoretical knowledge with real-life cases. To support this integration, it is essential to develop and provide specific case-based learning content¹⁹⁾.

Consistent findings across educational methods, assessment methods, and IPA indicate the need to enhance student practical procedural skills and clinical reasoning abilities. To activate the OSCE and CPX, the highest response indicated the necessity of developing diverse assessment modules. As previously mentioned, it is necessary to identify core procedure lists and develop OSCE checklists accordingly. For CPX, developing various modules to assess diagnostic and differential reasoning within a limited timeframe while maintaining authenticity remains challenging. The continuous development and utilization of diverse assessments, including formative evaluations, and ongoing development and modification through a peer review process framework are essential.

The second highest response was the need for facility and equipment expansion. Currently, many pieces of equipment are available in schools. However, education takes place in hospitals. Initially, separating the simulated skill training course before clinical practice in schools or providing educational tools at actual clinical sites where training occurs is necessary. In addition, the educational tools specific to Korean traditional medicine are insufficient. Review and adoption of acupuncture and diagnostic education tools from traditional Chinese medicine (TCM)²⁰⁾, chiropractic education tools from Western countries²¹⁾, and the concurrent development of significant educational and assessment tools within Korean educational and research institutions should be pursued.

This study had several limitations. The findings are based on an analysis of a single university case, which limits their generalizability to clinical clerkships across all educational institutions. Additionally, although the survey was conducted uniformly across faculty members from multiple departments, clinical reality may vary significantly among departments. However, as the expansion and enhancement of clinical clerkship education are anticipated, this study can serve as foundational data to explore future developmental strategies.

The current structure of clinical clerkships in Korean medicine education primarily involves observations in outpatient clinics and participation in procedural clerkships overseen by responsible professors or department heads. Assessment methods predominantly focus on knowledge. The primary area for improvement in clinical practice involves the development of diverse assessment methods. By discussing research on faculty demands regarding clinical clerkship and recent trends, such as the expansion of clinical clerkship hours, this study proposes to serve as foundational data for further discussions and improvements in clinical clerkship.