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Performance of Medical Students in a Nontraditional Rural Clinical Program, 199899 through 200304

Schauer, Roger W. MD; Schieve, Dean PhD

Academic Medicine:
doi: 10.1097/01.ACM.0000232409.20271.7a
Innovative Curricula

Purpose: To compare knowledge acquisition as measured by test scores for students in nontraditional clinical clerkships to scores for students in traditional urban hospital-based clerkships. Interdisciplinary and continuity-of-care clerkships in rural areas are the focus of the study.

Method: All the students’ Medical College Admission Test (MCAT) scores, National Board of Medical Examiners (NBME) subject exam scores, and United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores over a six-year period, 1998–99 to 2003–04, were compared for third-year students in nontraditional and traditional clerkships at the University of North Dakota School of Medicine and Health Sciences. Cohorts were 29 students in our Rural Opportunities in Medical Education (ROME) program and 296 students in traditional third-year clerkships. NBME subject exam scores were those in pediatrics, internal medicine, surgery, and obstetrics and gynecology. The exam used for family medicine is not standardized to national standards, but controlled within the Department of Family Medicine. MCAT and USMLE Step 1 scores were used as a means of controlling for prior academic achievement and ability.

Results: There were no significant differences (p ≥ .05) in MCAT scores, Step 1 scores, subject exam scores, or Step 2 scores between the two groups. In contrast, students from ROME scored higher (p ≤ .05) on the internal medicine clinical preceptor assessments than did students from the traditional track.

Conclusions: These findings suggest that students in remote, rural, longitudinal, integrated learning environments can attain fund-of-knowledge scores comparable to the scores of students in traditional clerkships, and may, as in this study, receive higher ratings for clinical proficiency.

Author Information

Dr. Schauer is director for predoctoral education, Department of Family Medicine, and is affiliated with the Office of Medical Education, University of North Dakota School of Medicine and Health Sciences. He is course director for Rural Opportunities in Medical Education (ROME) and course director for the state-wide third-year Family Medicine clerkship.

Dr. Schieve is an evaluation consultant to the office of Medical Education and Health Sciences, and is a principal with the firm DMD Consulting in Grand Forks, North Dakota.

Correspondence should be addressed to Dr. Schauer, Department of Family Medicine, Grand Forks, ND 58203-9037; e-mail: (

© 2006 Association of American Medical Colleges