Impact of the foundations of clinical medicine course on USMLE scores.
BACKGROUND
The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations.


OBJECTIVE
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.


METHODS
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.


METHODS
Students completing USMLE step 2 between 1999 and 2004 (n = 743).


METHODS
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.


RESULTS
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).


CONCLUSIONS
A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing.
Brownfield
Elisha L
EL
Medical University of South Carolina, Charleston, SC, USA. brownfe@musc.edu
Blue
Amy V
AV
Powell
Caroline K
CK
Geesey
Mark E
ME
Moran
William P
WP
D000328:Adult; D002982:Clinical Clerkship; D015510:Clinical Medicine / Q000193:education*; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008007:Licensure, Medical; D008297:Male; D012586:Science / Q000193:education*