title: Cohort study of examination performance of undergraduate medical students learning in community settings.
abstract: OBJECTIVE
  To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital.
  
  
  METHODS
  All 371 medical students who did their year 3 study from 1998-2002.
  
  
  METHODS
  Mean student examination score (%) at the end of year 3.
  
  
  RESULTS
  The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group).
  
  
  CONCLUSIONS
  These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.
authors.affiliation: Flinders University Rural Clinical School, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia. paul.worley@flinders.edu.au
authors.forename: Paul
authors.initials: P
authors.lastname: Worley
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.forename: David
authors.initials: D
authors.lastname: Prideaux
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D003154:Community Medicine / Q000193:education*; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D013021:South Australia; D013337:Students, Medical