This study's goal was to determine if completing Web cases improved students' performance on clerkship assessments.
We compared scores on preceptor evaluations, National Board of Medical Examiners (NBME) Subject Exam, and a standardized patient (SP)-based exam using ANCOVA for students choosing to complete assigned cases versus students not completing the assignment. We controlled for prior academic performance and clerkship timing using US Medical Licensing Exam (USMLE) Step 1 scores and rotation order.
Students completing the case assignment scored higher on the NBME subject exam and the SP-based exam.
Web-based learning was associated with improved student performance on clerkship assessments.
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[Show abstract][Hide abstract] ABSTRACT: Web-based cases are well accepted by medical students and enable faculty to deliver equivalent educational experiences to all students. A 2009 literature search revealed no study investigating student use patterns of Web-based case libraries for self-directed learning. We investigated third-year students' use of a Web-based case program for self-directed learning in a family medicine clerkship.
We analyzed Design A Case usage patterns of 210 medical students during academic year 2008--2009. We compared board score differences between these students and those from the previous 5 years who did not use Design A Case. We analyzed data from a 13-item survey, administered to a subgroup of 85 students, about the strengths, weaknesses, and acceptability of the program.
Students completed, on average, four cases, which was beyond the requirement of three. They reported that the content was highly relevant to cases they saw in clinic. Almost 75% preferred the self-directed Web-based learning over didactics, and most (64%) felt they learned more electronically. Use of the cases was associated with equivalent Board scores versus didactic lectures.
In our setting, self-directed learning using a Web-based case program was highly acceptable to students. Web-based cases may provide an option for family medicine educators who wish to deliver equivalent educational experiences across sites.
Family medicine 11/2009; 42(7):496-500. · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations.
We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores.
In 2001-2002, all third year students met weekly in groups of 8-12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases.
Students completing USMLE step 2 between 1999 and 2004 (n = 743).
Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders.
Students' average course evaluation score rose from 66 to 77 (2001-2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002-2004; n = 361) mean step 2 scores topped pre-FCM (1999-2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002).
A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.
Journal of General Internal Medicine 07/2008; 23(7):1002-5. DOI:10.1007/s11606-008-0631-z · 3.42 Impact Factor
[Show abstract][Hide abstract] 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.
Academic medicine: journal of the Association of American Medical Colleges 08/2009; 84(7):895-901. DOI:10.1097/ACM.0b013e3181a82013 · 2.93 Impact Factor