The results of an NBME Psychiatry Subject Test administered to TBL teams at four medical schools suggest that larger teams on later rotations score higher on a team NBME test. Individual NBME test scores and team cohesion were positively and significantly associated with team NBME test scores. These results suggest the need for additional studies focusing on team outcomes, team cohesion, team size, rotation and other factors as they relate to the effective and efficient performance of TBL teams in health science education.

We provide an overview of general competencies and specialty specific recommendations to serve as a foundation for medical schools to develop robust 4th-year curricula and for medical students to plan their 4th-year schedules.

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There is concordance among clerkship directors regarding the importance of identifying unprofessional behaviors among medical students although there exists a range of modalities for monitoring, remediating, and disciplining such behaviors.

Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.

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Clerkship grades can be effectively computed using various methods to examine knowledge and clinical skills. The addition of new methods of evaluation has added specificity to the performance feedback provided to the students completing the psychiatric clerkship. These changes have been viewed positively by department faculty and medical students. While requiring further refinement, they may eventually provide data to identify students requiring special attention in specific cognitive, relational, and clinical skill areas.