There are only a few studies in the field of extra-curricular academic learning activities, probably because of the methodological difficulty in this form of study. [7, 8] However, the rising incidence of students seeking alternative ways to learn medicine and increase their knowledge and skills makes it an extremely important issue that needs to be addressed.
Data collected reflects a major difference between the two groups of students. There are many reasons why students withdraw from the clerkship before they accomplish enough hours to fulfill the requirements for a proper certificate. Personal issues, excessive workload, the increasing service demand, night shifts, lack of sympathy of the health care providers may all be suggested as causes for abandoning the clerkship. However, those students who go on to complete the 200 hours appear to be well ahead in knowledge, skill and medical maturity.
Students in Group 2 outperformed students in Group 1 countless times over. This observation can be explained by the greater length of stay in the clerkship, so that the student is able to repeat over and over again whatever is needed to get used to it.
Furthermore, Group 2 requested 119.7% more radiographs than the Group 1 did. This number seems to be higher only because of their greater length of stay in the service, probably having no direct connection with the quality of their request or need for patient evaluation. However, when we interpret this with the number of supervised evaluations and follow up of the radiographs that the students performed, Group 2 did it almost four times more than Group 1 (273.8%). This seems to be related to better learning, and may even be a sign of maturity, as students begin to understand their own educational process. It is necessary for them to help in every steps of patient care to get the best picture in a better perspective of the entire process.
Also, the number of immobilization and sutures are directly proportional to the student’s number of hours in the clerkship. Although it can be assumed that the more a procedure is performed the better the student’s skill is, it has been proved that self-evaluation is not reliable as a good method to assess abilities . Rather, objective assessment should be applied.
Considering all fields, Group 2 made significantly more of the following procedures: 229% more plaster immobilizations, 211.2% more non-plaster immobilizations, 183.7% more single stitch sutures, 131% more Donatti stitch sutures and 650.2% more Resuscitation Room patient care, which reflect their experience and knowledge for future practice.
We can also observe that students in Group 2 discharged 187.6 times more patients than the ones in Group 2, what can also be explained by more hours in the clerkship. However, if we correlate the number of history taking with the number discharge orientation given to patients, we will find that in Group 2 only 29.4% of patients did not receive proper instructions and follow up, whereas this number rises to 49.6% in the Group 1.
Considering the possible harmful effects of having medical students working in an emergency department alone, all activities developed must be under supervision, what help their practical training process that will never be achieved only by books.[5, 9] Nevertheless, replacing curricular activities by extra-curricular ones shall be always discouraged. Not only but also, many Universities unfortunately do not offer a good enough plan of activities for their medical students, making regular lectures not a priority in their schedules (an issue that shall be addressed in a different paper).
Despite the better quality of medical care that can be offered by dedicated doctors compared to medical students, in Brazilian busy public emergency rooms most of the time it is impossible to dedicate the appropriate time on consultations to each patient (what may be the reality in most of the countries worldwide). Then, a team of committed medical students can be extremely helpful on patient care.
Even being non-licensed not-fully-trained, if properly supervised, they can play an important role in this environment. Tutors must be always aware of eventual medical errors that if not promptly approached will be under their legal responsibility as well as a threat to patients’ safety.
Since it is a surgical clerkship, it is expected that the vast majority of students aim to follow a surgical career beforehand (70.6%). However, data concerning the influence of the extra-curricular activity in their decision should be analyzed carefully. Most of the students that do not have interest on a surgical career and find the practical activities a bad influence for them may abandon it before its completion (500 hours), or even before 200 hours, and would not participate in the present study.