title: Internal medicine clerkship characteristics associated with enhanced student examination performance.
abstract: 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.
authors: University of Kentucky College of Medicine, Lexington, Kentucky, USA. cgrif00@uky.edu
authors: Charles H
authors: CH
authors: Griffith
authors: John F
authors: JF
authors: Wilson
authors: Steve A
authors: SA
authors: Haist
authors: T Andrew
authors: TA
authors: Albritton
authors: Bryan A
authors: BA
authors: Bognar
authors: Stuart J
authors: SJ
authors: Cohen
authors: Craig J
authors: CJ
authors: Hoesley
authors: Mark J
authors: MJ
authors: Fagan
authors: Gary S
authors: GS
authors: Ferenchick
authors: Othelia W
authors: OW
authors: Pryor
authors: Erica
authors: E
authors: Friedman
authors: Heather E
authors: HE
authors: Harrell
authors: Paul A
authors: PA
authors: Hemmer
authors: Bruce L
authors: BL
authors: Houghton
authors: Regina
authors: R
authors: Kovach
authors: David R
authors: DR
authors: Lambert
authors: Tayloe H
authors: TH
authors: Loftus
authors: Thomas D
authors: TD
authors: Painter
authors: Mark M
authors: MM
authors: Udden
authors: Raquel S
authors: RS
authors: Watkins
authors: Raymond Y
authors: RY
authors: Wong
mesh_terms: 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