Internal medicine clerkship characteristics associated with enhanced student examination performance.
OBJECTIVE
To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.
Griffith
Charles H
CH
University of Kentucky College of Medicine, Lexington, Kentucky, USA. cgrif00@uky.edu
Wilson
John F
JF
Haist
Steve A
SA
Albritton
T Andrew
TA
Bognar
Bryan A
BA
Cohen
Stuart J
SJ
Hoesley
Craig J
CJ
Fagan
Mark J
MJ
Ferenchick
Gary S
GS
Pryor
Othelia W
OW
Friedman
Erica
E
Harrell
Heather E
HE
Hemmer
Paul A
PA
Houghton
Bruce L
BL
Kovach
Regina
R
Lambert
David R
DR
Loftus
Tayloe H
TH
Painter
Thomas D
TD
Udden
Mark M
MM
Watkins
Raquel S
RS
Wong
Raymond Y
RY
D000124:Achievement; D002321:Career Choice; D002982:Clinical Clerkship / Q000458:organization & administration*; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D003479:Curriculum / Q000592:standards*; D005180:Faculty, Medical; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008007:Licensure, Medical; D008486:Physician Executives; D010817:Physician-Patient Relations; D011231:Preceptorship; D018794:Problem-Based Learning; D013044:Specialty Boards; D014481:United States