title: The association of students requiring remediation in the internal medicine clerkship with poor performance during internship.
abstract: OBJECTIVE
  To determine whether the Uniformed Services University (USU) system of workplace performance assessment for students in the internal medicine clerkship at the USU continues to be a sensitive predictor of subsequent poor performance during internship, when compared with assessments in other USU third year clerkships.
  
  
  METHODS
  Utilizing Program Director survey results from 2007 through 2011 and U.S. Medical Licensing Examination (USMLE) Step 3 examination results as the outcomes of interest, we compared performance during internship for students who had less than passing performance in the internal medicine clerkship and required remediation, against students whose performance in the internal medicine clerkship was successful. We further analyzed internship ratings for students who received less than passing grades during the same time period on other third year clerkships such as general surgery, pediatrics, obstetrics and gynecology, family medicine, and psychiatry to evaluate whether poor performance on other individual clerkships were associated with future poor performance at the internship level. Results for this recent cohort of graduates were compared with previously published findings.
  
  
  RESULTS
  The overall survey response rate for this 5 year cohort was 81% (689/853). Students who received a less than passing grade in the internal medicine clerkship and required further remediation were 4.5 times more likely to be given poor ratings in the domain of medical expertise and 18.7 times more likely to demonstrate poor professionalism during internship. Further, students requiring internal medicine remediation were 8.5 times more likely to fail USMLE Step 3. No other individual clerkship showed any statistically significant associations with performance at the intern level. On the other hand, 40% of students who successfully remediated and did graduate were not identified during internship as having poor performance.
  
  
  CONCLUSIONS
  Unsuccessful clinical performance which requires remediation in the third year internal medicine clerkship at Uniformed Services University of the Health Sciences continues to be strongly associated with poor performance at the internship level. No significant associations existed between any of the other clerkships and poor performance during internship and Step 3 failure. The strength of this association with the internal medicine clerkship is most likely because of an increased level of sensitivity in detecting poor performance.
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: Brian A
authors: BA
authors: Hemann
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: Steven J
authors: SJ
authors: Durning
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: William F
authors: WF
authors: Kelly
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: Ting
authors: T
authors: Dong
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: Louis N
authors: LN
authors: Pangaro
authors: Department of Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors: Paul A
authors: PA
authors: Hemmer
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D012073:Remedial Teaching / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States