Effects of Prior Clerkship Experience on End-of-Clerkship Performance in Pediatrics and Psychiatry

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Abstract

Perspective: US medical students are required to complete clerkships in core specialties before graduation, though the length and sequence of these clerkships vary across schools and students. While previous studies demonstrate the benefits of prior clinical experience on clerkship performance, the effects of clerkship length, sequence, and their interaction remains unclear.

Objective: This study examined the effects of previous clerkship experience on the National Board of Medical Examiners (NBME) pediatrics and psychiatry subject examinations. These examinations were taken as end-of-clerkship assessments.

Methods and Data Sources: Two sets of analyses were conducted, one with pediatrics scores as the dependent measure and another with psychiatry scores as the dependent measure. The pediatrics dataset included 27,584 examinees from 107 US medical schools that completed a pediatrics rotation and took the NBME pediatrics subject examination, and the psychiatry dataset included 32,001 students from 121 LCME-accredited schools that completed a psychiatry rotation and took the NBME psychiatry subject examination. Pediatrics examinees graduated between 2011 and 2014 and psychiatry examinees graduated between 2012 and 2013. For each dataset, a series of examinees-nested-in-schools hierarchical linear models was fit separately. For pediatrics, the clerkship predictors included family medicine, internal medicine, obstetrics and gynecology (ob/gyn), psychiatry, and surgery, while for psychiatry they included family medicine, internal medicine, ob/gyn, pediatrics, and surgery. Step 1 scores were used as a covariate to control for prior achievement. The study qualified for exempt status from the American Institutes for Research Institutional Review Board.

Results: For pediatrics, on average, examinees that completed a clerkship in internal medicine, ob/gyn, family medicine, surgery, and psychiatry scored 1.87, 0.96, 0.82, 0.68, 0.45 points higher, respectively (p<.005). Each additional week of pediatrics training was associated with a score gain of 0.44 points. Internal medicine length affected the relationship between internal medicine completion and pediatrics score, with an expected 0.17-point increase in the internal medicine coefficient for each additional week of internal medicine training. In terms of psychiatry, on average, examinees completing internal medicine, pediatrics, family medicine, and ob/gyn clerkships scored 1.06, 0.59, 0.43 and 0.38 points higher, respectively (p<.005). Previous completion of surgery was unrelated to performance in psychiatry. Each additional week of psychiatry training was associated with a score gain of 0.47 points.

Significance: Completion of prior clerkships increased scores on both the pediatrics and psychiatry end-of-clerkship examinations, with the largest benefit in both cases observed for internal medicine. Interestingly, completion of a surgery clerkship was associated with higher pediatrics scores, but not psychiatry scores. An understanding of these effects highlights the need for multiple measures of student achievement during clinical clerkships and could aid educators in designing and implementing curricular changes aimed at increasing student learning.

Authors

• Wenli Ouyang, National Board of Medical Examiners

• Monica M. Cuddy, National Board of Medical Examiners

• Jonathan Phung, National Board of Medical Examiners

• David B. Swanson, American Board for Medical Specialities