Internal medicine clerkship characteristics associated with enhanced student examination performance.
ABSTRACT To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance.
The authors collected data from 17 U.S. medical schools (1,817 students) regarding characteristics of their IM clerkships, including structural characteristics, pedagogical approaches, patient contact, and clinical teacher characteristics. Outcomes of interest were postclerkship National Board of Medical Examiners (NBME) subject examination score, United States Medical Licensing Examination (USMLE) 2 score, and change in score from USMLE 1 to 2. To examine how associations of various clerkship characteristics and examination performance may differ for students of different prior achievement, the authors categorized students into those who scored in the top (1/4) of the cohort on USMLE 1 and the bottom (1/4). The authors conducted analyses at both the school and the individual student levels.
In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement.
Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.
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ABSTRACT: One of the central tenets of Abraham Flexner's seminal report of 1910 was his firm belief that the medical school should be located within a university setting. He made this recommendation in the context of his era, when universities offered the best opportunities for ensuring that medical education would be firmly grounded in science and the scientific method of inquiry. Like many of Flexner's ideas, the organization of medical schools, including the new schools being developed today, continues in the image he propounded. At the same time, over the past decade, many reports have articulated the growing challenges of integrating medical schools-and, perhaps more important, academic medical centers-within the university. Is this relationship, once considered so crucial to the quality of medical education, still a mutually beneficial and symbiotic one? On the 100th anniversary of Flexner's report, the authors of this article explore the relevance and importance of the university-medical school relationship to the quality of medical education and consider the advantages and disadvantages for both medical schools and universities. A century later, the embedding of medical schools within university settings continues to offer unique and highly relevant opportunities to reclaim the foundation on which medical education must rest and to adhere to fundamental ideals that are too often threatened by contemporary challenges.Academic medicine: journal of the Association of American Medical Colleges 02/2010; 85(2):273-82. DOI:10.1097/ACM.0b013e3181c88471 · 3.47 Impact Factor
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ABSTRACT: Increasing the size of medical school classes has resulted in the use of community hospitals for emergency medicine (EM) clerkships. While differences in clinical experience are expected, it is unclear if they are significant. The authors set out to investigate whether or not clinical site affects student performance on a standard written exam as a measure of medical knowledge. This was a retrospective analysis of data from 2005 to 2009 for a mandatory fourth-year EM clerkship at one institution that uses academic (EM residency), hybrid (residency training site but not EM), and community (no residency programs) hospitals as clerkship sites. Multiple variable linear regression was used to examine the relationship between clerkship site and end of clerkship written exam score. Additional covariates included were the time of year the rotation was completed (by 3- or 4-month tertiles) and whether the student matched in EM. As test scores increased over the study period, a time factor was also included to account for this trend. A p-value of <0.05 was required for variable retention in the model. A total of 718 students completed the clerkship and had complete data for analysis. Thirty-five students matched in EM. A total of 311 rotated at academic sites, 304 at hybrid sites, and 103 at community sites. After adjusting for covariates, clinical site was not a significant predictor of exam score (F(2,691) = 0.42, p = 0.65). Factors associated with higher test score were student match in EM (beta coefficient = 3.4, 95% confidence interval [CI] = 1.0 to 5.7) and rotation in July through September (beta coefficient = 1.8, 95% CI = 0.5 to 3.0, against a reference of January through April). No significant interaction terms or confounders were identified. This study found no evidence that clerkship site affected final exam score. Academic EM clerkships may consider partnering with other hospitals for clinical experiences without compromising education.Academic Emergency Medicine 07/2011; 18(7):741-4. DOI:10.1111/j.1553-2712.2011.01104.x · 2.20 Impact Factor
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ABSTRACT: This study aims to determine the feasibility of incorporating structured therapeutic consultations (TCs) into the clinical clerkship internal medicine. TCs were considered feasible if students were able to draw up a therapeutic plan and carry out a TC, and if students and their supervisors considered TCs workable and useful. From March 2008 to October 2009, medical students carried out a "diagnostic" and subsequent "therapeutic" consultation with the same patient during their clinical clerkship internal medicine at the VU University Medical Center. After the diagnosis was established, the student had to formulate a therapeutic plan and then carry out a TC with the patient, supervised by a clinician. The supervisor assessed the therapeutic plan and how the student conducted the TC. Both the student and the supervisor received a questionnaire about the workability and usefulness of the TC. On average, students' performance in drawing up a therapeutic plan was awarded a score of 4.4 on a five-point scale, and the TC performance of 96 % of the students was considered amply sufficient or better. Eighty-three percent of the supervisors agreed or strongly agreed with the statement that the TC is a worthwhile addition to the clerkship, and 67 % of the students indicated that they would like to perform more TCs. This study shows that incorporating a structured TC with a real patient into the clinical clerkship internal medicine is both feasible and worthwhile. This may be an important step to improving the prescribing skills and attitudes of junior doctors and residents and to reducing their prescribing errors after graduation.Archiv für Experimentelle Pathologie und Pharmakologie 08/2012; 385(11):1111-6. DOI:10.1007/s00210-012-0775-6 · 2.36 Impact Factor