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Academic Performance of Longitudinal Integrated Clerkship Versus Rotation-Based Clerkship Students: A Matched-Cohort Study

Myhre, Douglas L. MD; Woloschuk, Wayne PhD; Jackson, Wesley MD; McLaughlin, Kevin MB ChB, PhD

doi: 10.1097/ACM.0000000000000110
Research Reports

Purpose Prior studies suggest that students on a longitudinal integrated clerkship (LIC) have comparable academic performance to those on a rotation-based clerkship (RBC); however, most of these studies did not adjust for preclerkship academic performance. The objective of this study was to compare the academic performance of LIC and RBC students matched on prior academic performance over a three-year period.

Method Each LIC student in the University of Calgary classes of 2009, 2010, and 2011 (n = 34) was matched with four RBC students (n = 136) of similar prior academic performance. Knowledge and clinical skills performance between the streams was compared. Knowledge was evaluated by internal summative examinations and the Medical Council of Canada Part 1 licensing exam. Clinical skills were evaluated via in-training evaluation report (ITERs) and performance on the clerkship objective structured clinical examination (OSCE). Meta-analysis was used to compare knowledge evaluations and clinical performance for all core clerkship disciplines, and pooled effect sizes from the fixed-effect models were reported.

Results Meta-analyses showed no statistically significant heterogeneity. There were no differences between LIC and RBC students on knowledge evaluations (pooled effect size 0.019; 95% confidence interval [−0.155, 0.152], P = .8), ITERs (pooled effect size −0.015 [−0.157, 0.127], P = .8), or mean OSCE ratings (67.9 [SD = 4.6] versus 68.6 [SD = 5.8], P = .5).

Conclusions After matching on prior academic performance, LIC and RBC students at one school had comparable performance on summative evaluations of knowledge, clinical performance, and clinical skills over three years.

Dr. Myhre is associate dean for distributed learning and rural initiatives, University of Calgary, Calgary, Alberta, Canada.

Dr. Woloschuk is director of program evaluation, Office of Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada.

Dr. Jackson is director, Rural Integrated Community Clerkship, University of Calgary, Calgary, Alberta, Canada.

Dr. McLaughlin is assistant dean of undergraduate medical education, University of Calgary, Calgary, Alberta, Canada.

Editor’s Note: Commentaries by D.A. Hirsh, E.S. Holmboe, and O. ten Cate and by C.D. Stevens, L. Wilkerson, and S. Uijtdehaage appear on pages 201–204 and 205–207.

Funding/Support: None reported.

Other disclosures: Drs. Myhre and Jackson were administrators of the University of Calgary Rural Integrated Community Clerkship during the time of this study.

Ethical approval: This study was carried out as one of the objectives cited in the three-year evaluation plan of the longitudinal integrated clerkship program, which received ethical approval from the conjoint health ethics board at the University of Calgary.

Previous presentations: Dr. Myhre presented these findings at the Consortium of Longitudinal Integrated Clerkships (CLIC) Rendez-Vous 2012 conference in Thunder Bay, Canada.

Correspondence should be addressed to Dr. McLaughlin, University of Calgary, Office of Undergraduate Medical Education, 3330 Hospital Dr. NW, Calgary, Alberta T2N 4N1; telephone: (403) 220-4252; fax: (403) 210-3852; e-mail:

© 2014 by the Association of American Medical Colleges