Purpose: To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance.
Method: The authors collected data from 17 U.S. medical schools (1,817 students) regarding characteristics of their IM clerkships, including structural characteristics, pedagogical approaches, patient contact, and clinical teacher characteristics. Outcomes of interest were postclerkship National Board of Medical Examiners (NBME) subject examination score, United States Medical Licensing Examination (USMLE) 2 score, and change in score from USMLE 1 to 2. To examine how associations of various clerkship characteristics and examination performance may differ for students of different prior achievement, the authors categorized students into those who scored in the top ¼ of the cohort on USMLE 1 and the bottom ¼. The authors conducted analyses at both the school and the individual student levels.
Results: In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement.
Conclusion: Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.
Dr. Griffith is professor of medicine, University of Kentucky College of Medicine, Lexington, Kentucky.
Dr. Wilson is professor of behavioral science, University of Kentucky College of Medicine, Lexington, Kentucky.
Dr. Haist is associate vice president for test development, National Board of Medical Examiners, Philadelphia, Pennsylvania.
Dr. Albritton is professor of medicine, Medical College of Georgia, Augusta, Georgia.
Dr. Bognar is associate professor of internal medicine, University of South Florida College of Medicine, Tampa, Florida.
Dr. Cohen is associate professor of medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Dr. Hoesley is associate professor, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Dr. Fagan is professor of medicine, Brown University School of Medicine, Providence, Rhode Island.
Dr. Ferenchick is professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
At the time of this study, Dr. Pryor was assistant professor of internal medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
Dr. Friedman is associate dean for undergraduate medical education, Mount Sinai School of Medicine, New York, New York.
Dr. Harrell is associate professor of medicine, University of Florida College of Medicine, Gainesville, Florida.
Dr. Hemmer is professor of medicine, Uniformed Services University of the Health Sciences–F. Edward Hebert School of Medicine, Bethesda, Maryland.
Dr. Houghton is associate professor of medicine, Creighton University School of Medicine, Omaha, Nebraska.
Dr. Kovach is director, Third-Year Curriculum, Southern Illinois University School of Medicine, Springfield, Illinois.
Dr. Lambert is senior associate dean of medical student education, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Dr. Loftus is professor of medicine, State University of New York Upstate Medical University, Syracuse, New York.
Dr. Painter is professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Dr. Udden is professor of medicine, Baylor College of Medicine, Houston, Texas.
Dr. Watkins is assistant professor of medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Dr. Wong is program director, Student Education in Internal Medicine, Loma Linda University School of Medicine, Loma Linda, California.
Please see the end of this article for information about the authors.
Correspondence should be addressed to Dr. Griffith, K507 Kentucky Clinic, Lexington, KY, 40536-0284; telephone: (859) 257-5499; fax: (859) 257-2605; e-mail: (firstname.lastname@example.org).