title: Fourth-Year Medical School Course Load and Success as a Medical Intern.
abstract: BACKGROUND
  The fourth year of medical school has come under recent scrutiny for its lack of structure, cost- and time-effectiveness, and quality of education it provides. Some have advocated for increasing clinical burden in the fourth year, while others have suggested it be abolished.
  
  
  OBJECTIVE
  To assess the relationship between fourth-year course load and success during internship.
  
  
  METHODS
  We reviewed transcripts of 78 internal medicine interns from 2011-2013 and compared the number of intensive courses (defined as subinternships, intensive care, surgical clerkships, and emergency medicine rotations) with multi-source performance evaluations from the internship. We assessed relative risk (RR) and 95% confidence interval (CI) of achieving excellent scores according to the number of intensive courses taken, using generalized estimating equations, adjusting for demographics, US Medical Licensing Examination (USMLE) Step 1 board scores, and other measures of medical school performance.
  
  
  RESULTS
  For each additional intensive course taken, the RR of obtaining an excellent score per intensive course was 1.05 (95% CI 1.03-1.07,P< .001), whereas the RR per nonintensive course taken was 0.99 (95% CI 0.98-1.00,P= .03). An association of intensive course work with increased risk of excellent performance was seen across multiple clinical competencies, including medical knowledge (RR 1.08, 95% CI 1.04-1.11); patient care (RR 1.07, 95% CI 1.04-1.10); and practice-based learning (RR 1.05, 95% CI 1.03-1.09).
  
  
  CONCLUSIONS
  For this single institution's cohort of medical interns, increased exposure to intensive course work during the fourth year of medical school was associated with better clinical evaluations during internship.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Richards
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.forename: Nikki
authors.initials: N
authors.lastname: DeMelo
authors.forename: C Christopher
authors.initials: CC
authors.lastname: Smith
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D005791:Patient Care