September 14, 2010 — Third-year medical student performance is associated with the first clinical clerkship, with students who start with internal medicine showing the highest subject examination performance and overall grades.
However, clerkship order is not associated with clerkship clinical performance or US Medical Licensing Examination Step 2 scores.
The findings, from a retrospective review of medical students attending a single US medical school, are published in the September 15 issue of the Journal of the American Medical Association.
"Studies have demonstrated the importance of clerkship sequence on aspects of performance in select clerkships, and their findings support that students perform better on subject examinations as they progress through the academic year," write Susan M. Kies, EdD, from the University of Illinois College of Medicine, Urbana, and colleagues. "Although research supports that students perform better in clerkship examinations later in the year, we are not aware of any studies that have addressed whether knowledge is gained as a result of a certain clerkship specialty,"
Accordingly, in this study, the authors sought to assess whether the order in which third-year core clerkships are completed affects student performance.
They analyzed the clerkship performance records of 2216 medical students at all 4 campuses of the University of Illinois College of Medicine who completed their third-year core clerkships in internal medicine, family medicine, surgery, pediatrics, psychiatry, and obstetrics/gynecology from July 2000 through June 2008.
They found that first clerkship was significantly associated with mean subject examination scores. For family medicine, it was 71.96 (95% confidence interval [CI], 70.90 - 72.98); internal medicine, 73.86 (95% CI, 73.33 - 74.39); obstetrics/gynecology, 72.36 (95% CI, 71.64 - 73.04); pediatrics, 73.11 (95% CI, 72.38 - 73.84); psychiatry, 72.17 (95% CI, 71.52 - 72.81); and surgery, 72.37 (95% CI, 71.73 - 73.02; P < .001).
Similarly, first clerkship was significantly associated with mean overall clerkship grades. For family medicine, it was 24.20 (95% CI, 23.90 - 24.90); internal medicine, 25.33 (95% CI, 25.07 - 25.60); obstetrics/gynecology, 24.68 (95% CI, 24.32 - 25.05); pediatrics, 24.92 (95% CI, 24.59 - 25.27); psychiatry, 24.61 (95% CI, 24.33 - 25.01); and surgery, 24.97 (95% CI, 24.64 - 25.30; P = .01).
The study also found a significant difference in mean total overall clerkship grades for students taking internal medicine first compared with obstetrics/gynecology (mean difference, 0.65; 95% CI, 0.18 - 1.12), psychiatry (mean difference, 0.66; 95% CI, 0.20-1.12) and family medicine (mean difference, 0.93; 95% CI, 0.37 - 1.50).
The positive association between starting a clerkship with internal medicine and subsequent examination performance throughout the clerkship sequence may be a reflection of a general understanding of internal medicine concepts that provide a basis of medical knowledge that extends to all clinical disciplines, the authors note.
"Having taken the internal medicine clerkship, students may have the basic understanding of these concepts and an advantage in standardized examination performance thereafter," they write.
The University of Illinois may not be representative of a typical medical school because of the diversity of its 4 campuses, the authors note. Other study limitations include the retrospective and observational study design, incomplete randomization to first clerkship, and variation in clerkship experience among the different campuses.
"The success of student clinical performance may be related to factors other than those included within the scope of this study," the authors write in their conclusion. "Additional analyses of student performance in the clinical setting and in other institutions may help provide optimal experiences for students."
The study authors have disclosed no relevant financial relationships.
JAMA. 2010;304:1220-1226.
No comments:
Post a Comment