Longer Rotations, Better Learning: WashU Redesigns the Pediatrics Clerkship

Medical educators have long wrestled with a stubborn problem: the clinical clerkships that form the backbone of the third year of medical school are often fragmented, unpredictable, and compressed into blocks so short that students barely settle into a clinical team before they are rotated off to the next service. A new study from Washington University School of Medicine in St. Louis, published in BMC Medical Education, reports that a radical restructuring of the pediatrics clerkship not only proved feasible to deliver but was met with strikingly high satisfaction from the students who experienced it. The redesign, part of the school’s broader Gateway Curriculum renewal, lengthened rotations, front-loaded foundational knowledge, protected uninterrupted immersive clinical time, and added a dedicated consolidation week for assessment, reflection, coaching, and community service.

The motivation behind the project was twofold. First, the authors point to persistent challenges in undergraduate pediatric education, where students frequently arrive on the wards underprepared for the distinctive communication skills, developmental considerations, and family dynamics that caring for children demands. Second, pediatrics faces a worsening physician-workforce shortage, a trend that has alarmed department chairs across the United States. While no single curricular tweak can solve a workforce crisis, the research team reasoned that clerkship factors are modifiable, and that a thoughtfully redesigned clerkship could create conditions known from the literature to be associated with students’ specialty choices. In other words, if the pediatrics experience itself is engaging, well-organized, and supportive, more students may consider pediatrics as a career, and all students should leave better prepared to care for young patients regardless of the specialty they ultimately choose.

The structural changes were substantial. The clerkship’s length was increased, giving students more sustained exposure to pediatric patients and clinical teams. Before and alongside clinical duties, students received dedicated foundational-knowledge preparation, ensuring they approached patient encounters with the vocabulary and conceptual framework that pediatrics requires. The clinical experience itself was designed to be immersive and uninterrupted, minimizing the scheduling churn that traditionally pulls students out of patient care for lectures and administrative obligations. Perhaps the most distinctive element was the consolidation week, referred to by the abbreviation ARCC, standing for Assessments, Reflection, Coaching, and Community. During this week, students completed formal assessments, reflected on their clerkship experiences, received coaching, and participated in community service, all deliberately separated from the daily pressures of the wards.

To evaluate whether this ambitious redesign could actually be delivered in practice, the investigators measured process outcomes, specifically feasibility and acceptability, over three consecutive academic years. Required student-satisfaction surveys were distributed between February and December in the years 2022 through 2024. Satisfaction was quantified on a four-point scale ranging from one, indicating very dissatisfied, to four, indicating very satisfied. Beyond the numbers, students were asked to describe in their own words what was working well and what was not. The quantitative responses were analyzed with descriptive statistics, while the open-ended comments underwent inductive thematic analysis, a qualitative method in which themes emerge from the data itself rather than being imposed by a predetermined coding framework.

The participation rate alone was remarkable: 342 of 350 eligible students completed the surveys, a 97.7 percent response rate that lends considerable weight to the findings. Those students reported high levels of satisfaction with the new clerkship structure, including the quality of the clinical experiences and the overall clerkship. In the qualitative analysis, several consistent themes emerged. Students valued the increased length of the rotations, the clear organization and structure of the course, the opportunities for hands-on learning, the variety of clinical experiences offered, and, notably, the community service and reflection components. That students singled out reflection and service, elements often dismissed as soft additions in tightly packed curricula, suggests these touchpoints played a genuine role in helping students process the emotional and professional dynamics of caring for sick children and their families.

Satisfaction surveys capture perception, but critics of curricular innovation often ask a harder question: did students actually learn as much? To address this, the team collected mean equated percent correct scores on the pediatrics subject examination, a standardized National Board of Medical Examiners test administered nationally, for academic years 2022 to 2023, 2023 to 2024, and 2024 to 2025. Their students’ mean scores were at or above the reported national averages across those years. This is a critical technical point, because it demonstrates that the redesign did not trade knowledge acquisition for student comfort. The dedicated foundational-knowledge preparation and the protected immersive clinical time appear to have supported, rather than diluted, high-yield medical learning.

The authors frame these results through the lens of continuous quality improvement, an approach borrowed from industrial engineering and increasingly applied to medical education. Data collection was embedded in the Gateway Curriculum’s larger quality-improvement machinery, and the dissemination of process outcomes was reviewed by the Institutional Review Board at Washington University in St. Louis, which deemed the evaluation non-human-subjects research under federal regulations, since it constituted program evaluation rather than research on identifiable individuals. The study also adhered to the Declaration of Helsinki and relevant guidelines, and the team followed the DoCTRINE framework, Defined Criteria To Report INnovations in Education, which standardizes how educational innovations are described so that other institutions can evaluate and adapt them.

What makes this study resonate beyond St. Louis is its explicit theory of change. Rather than treating the pediatric workforce shortage as an intractable pipeline problem, the researchers targeted modifiable clerkship factors: time, structure, preparation, and reflective practice. The successful delivery of the redesigned clerkship supported students’ pediatric patient-care skill preparation and their perceived readiness to engage in clinical encounters, while simultaneously addressing areas known from the literature to influence specialty choice. A student who feels competent, supported, and intellectually engaged during a clerkship is more likely to view that specialty favorably, and the ARCC week’s coaching and reflection may further shape professional identity formation, the gradual process by which medical students come to see themselves as future physicians of a particular kind.

There are, of course, limits to what a single-institution process evaluation can establish. The study reports feasibility and acceptability, not long-term outcomes such as match rates into pediatrics residency programs, retention of knowledge over time, or patient-care quality attributable to the redesign. The subject-exam comparison relies on reported national averages rather than a randomized control group, and the satisfaction data, while overwhelmingly positive and drawn from nearly the entire student cohort, reflect one institution’s culture and resources. Reproducing a longer clerkship also requires institutional investment in scheduling, faculty coaching capacity, and community-service partnerships that not every medical school can readily muster.

Nevertheless, the findings offer a concrete, evidence-based template for institutions contemplating their own curriculum renewals. The message from WashU Medicine is that clerkship redesign, done systematically and evaluated rigorously, can simultaneously meet educational-programmatic goals and cultivate the positive experiences that may draw more physicians into pediatrics at a moment when children’s health care desperately needs them. As medical schools nationwide continue to overhaul their curricula for a new generation of learners, this pediatrics clerkship experiment stands as a compelling proof of concept: give students time, structure, preparation, and space to reflect, and they will not only learn more, they will appreciate the journey. The article is published open access, allowing educators everywhere to examine the model in detail and consider how its principles might translate to their own wards, clinics, and communities.

Subject of Research: Curriculum redesign and evaluation of the pediatrics clerkship in undergraduate medical education

Article Title: Feasibility and acceptability of an innovative curriculum redesign: the pediatrics clerkship at WashU Medicine

Article References: Pérez, M., Engle, D. L., Wyatt, A. T. M., Hall, L., Wallace, C. M., Bram, S., Emke, A. R., De Fer, T. M., & Colson, E. R. (2026). Feasibility and acceptability of an innovative curriculum redesign: the pediatrics clerkship at WashU Medicine. BMC Medical Education. https://doi.org/10.1186/s12909-026-10531-0

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10531-0

Keywords: medical education, pediatrics clerkship, curriculum redesign, undergraduate medical education, student satisfaction, feasibility and acceptability, clerkship structure, NBME subject exam, physician workforce shortage, reflection and coaching, community service, WashU Medicine