The Impact of Shortened Clinical Clerkships on Medical Student Performance and Clerkship Assessment

Abstract

Intro Medical schools sometimes need to adjust the length of third-year clinical clerkships. The literature surrounding the effects of shortened clerkships on student experience and performance is mixed. Methods Our medical school shortened the third year by an average of 20% per clerkship to accommodate a curricular redesign in 2018-2019. We examined test scores and measures of clinical performance as well as student experience in order to understand the impact of this change. Results Two hundred and eight students were included in the analysis, 104 in each cohort. No statistically significant differences were noted between cohorts on NBME subject examination results. There were no significant differences on Step 2 CK scores between the traditional curriculum cohort (M = 249.4, SD = 13.7) and shortened curriculum cohort (M = 248.7, SD = 15.8). Student performance on OSCE cases was similar. Similar percentages of students rated each clerkship either "good" or "excellent" in the traditional (77%) and shortened (78%) curriculum. Conclusion There was no significant impact on student test scores after shortening the curriculum. Measures of student satisfaction and experience also remained stable, likely related to emphasis on retaining patient care experiences and streamlining of didactics. Curricular shortening during the third year of medical school was feasible and safe from the student perspective in our experience.

Clerkship length: Does it affect performance on the NBME Surgery Subject Examination across schools?

“…[7][8] In the remaining study, a reduction from 6 to 5 weeks led to slightly higher performance for the longer-clerkship group (Surgery Subject Examination scores were approximately 1 point higher on the equated percent correct scale). 9 These studies varied in how pre-existing differences between groups completing shorter and longer clerkships were taken into account. In some, differences were modeled directly using Step 1 scores.…”

“…In some, differences were modeled directly using Step 1 scores. 9,11 In others, researchers tested for differences between pre-clerkship measures such as Medical College Admission Test (MCAT) scores, undergraduate grade point averages (GPAs), and Step 1 scores prior to comparing clerkship performance. 5,10 In three studies, the researchers did not statistically control for preclerkship differences, or simply noted that the two groups were similar.…”

“…Based on previous ndings, a minimum of ve weeks appears to be the limit, although our sample included two schools with four-week surgery clerkships whose students performed similarly to those in schools with longer clerkships. 9 As previously noted, when institutions and clerkship directors contemplate changes to their curriculum, length should not be the only consideration. Factors such as healthcare team opportunities, diversity of the patient population, and curriculum structure are also likely to play a key role in student learning.…”

“…8 Another study from 2021 based on data from Wake Forest School of Medicine painted a more complex picture: after a reduction in clerkship length from 6 to 5 weeks, differences in Surgery Subject Examination scores were non-signi cant in an initial analysis, but signi cant once Step 1 scores were used to control for variation in basic science knowledge between the two cohorts. 9 Students who completed the longer clerkship had slightly higher scores (approximately 1 point higher on the equated percent correct scale). In the same study, there were no signi cant differences in the percentage of students who rated the surgery clerkship as "good" or "excellent.…”

Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19

“…Several prior studies have concluded that longer Medicine clerkship length is associated with higher clinical subject exam scores, while other studies showed a lack of effect on the NBME score related to clerkship length [ 9 , 10 ]. The aim of the study was to determine whether shortening the IM clerkship time would affect the comprehensive NBME Medicine subject exam performance and also determine if students felt they had enough time to complete the IM clerkship requirements.…”