title: Breadth versus volume: Neurology outpatient clinic cases in medical education.
abstract: This study examined how volume in certain patient case types and breadth across patient case types in the outpatient clinic setting are related to Neurology Clerkship student performance. Case logs from the outpatient clinic experience of 486 students from The University of Chicago Pritzker School of Medicine, USA, participating in the 4week Neurology Clerkship from July 2008 to June 2013 were reviewed. A total of 12,381 patient encounters were logged and then classified into 13 diagnostic categories. How volume of cases within categories and the breadth of cases across categories relate to the National Board of Medical Examiners Clinical Subject Examination for Neurology and a Neurology Clerkship Objective Structured Clinical Examination was analyzed. Volume of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.290, p<.001), the Objective Structured Clinical Examination physical examination (r=.236, p=.011), and the Objective Structured Clinical Examination patient note (r=.238, p=.010). Breadth of cases was significantly correlated with the National Board of Medical Examiners Clinical Subject Examination for Neurology (r=.231, p=.017), however was not significantly correlated with any component of the Objective Structured Clinical Examination. Volume of cases correlated with higher performance on measures of specialty knowledge and clinical skill. Fewer relationships emerged correlating breadth of cases and performance on the same measures. This study provides guidance to educators who must decide how much emphasis to place on volume versus breadth of cases in outpatient clinic learning experiences.
authors.affiliation: Nationwide Children's Hospital, Ohio State University, Division of Neurology, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: dara.albert@nationwidechildrens.org.
authors.forename: Dara V
authors.initials: DV
authors.lastname: Albert
authors.affiliation: Rush Medical College, Rush University, IL, USA.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Blood
authors.affiliation: University of Illinois at Chicago, Department of Medical Education, IL, USA.
authors.forename: Yoon Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: University of Chicago, Department of Neurology, IL, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Brorson
authors.affiliation: University of Chicago, Department of Neurology, IL, USA.
authors.forename: Rimas V
authors.initials: RV
authors.lastname: Lukas
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D002982:Clinical Clerkship / Q000592:standards* / Q000706:statistics & numerical data; D003479:Curriculum; D004501:Education, Medical / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D009462:Neurology / Q000193:education* / Q000706:statistics & numerical data
keywords: Case logs; Medical education; Neurology clerkship; Neurology education