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Does Performance on Evidence-Based Medicine and Urgent Clinical Scenarios Assessments Deteriorate During the Fourth Year of Medical School? Findings From One Institution

Heidemann, Lauren A., MD; Keilin, Charles A.; Santen, Sally A., MD, PhD, MHPE; Fitzgerald, James T., PhD; Zaidi, Nikki L., PhD; Whitman, Laurie, MSE; Jones, Elizabeth K., MD; Lypson, Monica L., MD, MHPE; Morgan, Helen K., MD

doi: 10.1097/ACM.0000000000002583
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Purpose The fourth year of medical school (M4) should prepare students for residency yet remains generally unstructured, with ill-defined goals. The primary aim of this study was to determine whether there were performance changes in evidence-based medicine (EBM) and urgent clinical scenarios (UCS) assessments before and after M4 year.

Method University of Michigan Medical School graduates who matched into internship at Michigan Medicine completed identical assessments on EBM and UCS at the beginning of M4 year and 13 months later during postgraduate year 1 (PGY1) orientation. Individual scores on these assessments were compared using paired t test analysis. The associations of academic performance, residency specialty classification, and initial performance on knowledge changes were analyzed.

Results During academic years 2014 and 2015, 76 students matched into a Michigan Medicine internship; 52 completed identical EBM stations and 53 completed UCS stations. Learners’ performance on the EBM assessment decreased from M4 to PGY1 (mean 93% [SD = 7%] vs. mean 80% [SD = 13%], P < .01), while performance on UCS remained stable (mean 80% [SD = 9%] vs. mean 82% [SD = 8%], P = .22). High M4 performers experienced a greater rate of decline in knowledge level compared with low M4 performers for EBM (−20% vs. −4%, P = .01). Residency specialty and academic performance did not affect performance.

Conclusions This study demonstrated degradation of performance in EBM during the fourth year and adds to the growing literature that highlights the need for curricular reform during this year.

L.A. Heidemann is clinical assistant professor of internal medicine, University of Michigan Medical School, Ann Arbor, Michigan.

C.A. Keilin is a medical student, University of Michigan Medical School, Ann Arbor, Michigan.

S.A. Santen was assistant dean of evaluation and assessment and professor of emergency medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan, at the time the study was conducted. She is currently senior associate dean, Evaluation, Assessment, and Scholarship of Learning, Virginia Commonwealth University School of Medicine, Richmond, Virginia.

J.T. Fitzgerald is professor, Department of Learning Health Sciences, University of Michigan, and Geriatric Research Education and Clinical Center, Arbor VA Medical Center, Ann Arbor, Michigan.

N.L. Zaidi is associate director of advancing scholarship, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan.

L. Whitman is standardized patient program manager and educator, University of Michigan Medical School, Ann Arbor, Michigan.

E.K. Jones is clinical assistant professor of family medicine, University of Michigan Medical School, Ann Arbor, Michigan.

M.L. Lypson is director of medical and dental education, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and adjunct professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

H.K. Morgan is director, Comprehensive Clinical Assessment, and clinical associate professor of obstetrics and gynecology and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

Funding/Support: None reported.

Other disclosures: University of Michigan Medical School is a part of the American Medical Association (AMA) Accelerating Change in Medical Education Consortium. Sally A. Santen and Helen K. Morgan have been co-principal investigators on this AMA consortium grant.

Ethical approval: The study was determined to be not regulated by the University of Michigan Institutional Review Board (HUM00131053).

Disclaimers: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the U.S. Government.

Previous presentations: Association of American Medical Colleges (AAMC) Organization of Student Representatives (OSR) Student Programming Showcase, November 2, 2017, Boston, Massachusetts; and Central Group on Education Affairs (CGEA) Regional Conference, March 22, 2018, Rochester, Minnesota.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A626.

Correspondence should be addressed to Lauren A. Heidemann, Department of Internal Medicine, 3119 Taubman Center, 1500 E. Medical Center Dr., SPC 5376, Ann Arbor, MI 48109-5376; e-mail: lheidema@med.umich.edu.

© 2019 by the Association of American Medical Colleges