Impact of Students' Scheduling Choice on Clerkship Examination Score Performance in a Time-Varying Competency-Based Curriculum.

PURPOSE: Standardized end-of-clerkship examinations typically occur on the last day of the clerkship. However, recent trends toward time-varying competency-based medical education have offered students more test scheduling flexibility, creating an opportunity to study the impact of student-selected examination timing. METHOD: Starting with the graduating class of 2018, students took the required standardized end-of-core clerkship examinations at any available time they chose during their clinical years. Before this change, these examinations were administered to all students on the last day of the clerkship. Students' examination dates relative to clerkship completion were analyzed between 2017 and 2020 (inclusive of before and after flexible exam timing) to assess the impact that student-selected exam timing had on test performance on National Board of Medical Examiners shelf clinical science examinations for required core clerkships. RESULTS: Data on 146 medical students in 2017 (fixed exam timing) and 466 medical students between 2018 and 2020 (flexible exam timing) were included. Among students offered flexible exam timing, between 2.7% (internal medicine) and 14.6% (psychiatry) took their exam before actually taking clerkship, while between 22.7% (psychiatry) and 40.0% (surgery) took their exam more than 90 days after the clerkship ended. Exam scores were statistically higher for those who took the exam at a time of their choosing compared with those who were required to take it at the end of individual rotations and when the exam scores were combined (fixed exam timing mean = 73.9, standard deviation [SD] = 7.8; flexible exam timing mean = 77.4, SD = 6.0, P < .001). The percent of students with passing scores was statistically higher in internal medicine, pediatrics, and psychiatry. CONCLUSIONS: Self-selection of shelf exam timing appears to increase shelf exam scores. As more medical schools transition to competency-based medical education, providing scheduling flexibility appears not to negatively affect student achievement.

Preclinical Assessment Performance as a Predictor of USMLE Step 1 Scores or Passing Status.

PURPOSE: To determine the association between student performance on preclinical pass/fail assessments in an allopathic medical school curriculum and Step 1 scores or passing status. MATERIALS AND METHODS: This observational retrospective study involved preclinical assessments, including National Board of Medical Examiners Customized Assessment Services (NBME CAS) exams, faculty developed exams, and the United States Medical Licensing Examination (USMLE) Step 1 from 582 medical students in four cohorts (2018-2021). Analyses included descriptive statistics, Pearson's correlation coefficient (ρ) and logistic regression, presented as odds ratios (ORs) and associated p values. RESULTS: Mean scores on Component 4 end-of-block NBME CAS examinations positively correlated with Step 1 scores (ρ = 0.83, p < .001), as did mean scores on both Component 1 weekly faculty-created assessments and Component 3 end-of-block faculty-created assessments (ρ = 0.70, p < .001; ρ = 0.73, p < .001). Passing all Component 3 end-of-block faculty-created assessments in all blocks was associated with passing Step 1 (OR = 8.66, p < .001). Independently, passing all Component 4 NBME CAS exams or passing all Component 1 weekly faculty-derived assessments in all blocks did not correlate with passing Step 1 (OR = 2.40, p = .12.; OR = 0.29, p = .30). Passing all assessment types in all blocks was among the strongest correlators with passing Step 1 (OR = 9.026, p < .001). CONCLUSIONS: Scores on faculty-derived and NBME CAS end-of-block assessments were positively correlated with Step 1 scores. Passing status on institution-derived end-of-block assessments was associated with passing Step 1, whereas passing status on weekly institution-derived assessments or end-of-block NBME CAS assessments was not associated with passing Step 1. End-of-block pass/fail NBME CAS and faculty-derived preclinical examinations may help prepare students for Step 1 and predict their outcomes. Weekly faculty-created assessments should primarily be used to continuously reinforce educational material.

Development and evaluation of a simulation-based transition to clerkship course.

BACKGROUND: Transition to clerkship courses bridge the curricular gap between preclinical and clinical medical education. However, despite the use of simulation-based teaching techniques in other aspects of medical training, these techniques have not been adequately described in transition courses. We describe the development, structure and evaluation of a simulation-based transition to clerkship course. APPROACH: Beginning in 2012, our institution embarked upon an extensive curricular transformation geared toward competency-based education. As part of this effort, a group of 12 educators designed, developed and implemented a simulation-based transition course. The course curriculum involved seven goals, centered around the 13 Association of American Medical Colleges Core Entrustable Professional Activities for entering residency. Instructional techniques included high-fidelity simulation, and small and large group didactics. Student competency was determined through a simulation-based inpatient-outpatient objective structured clinical examination, with real-time feedback and remediation. The effectiveness of the course was assessed through a mixed methods approach involving pre- and post-course surveys and a focus group. EVALUATION: Of 166 students, 152 (91.6%) completed both pre- and post-course surveys, and nine students participated in the focus group. Students reported significant improvements in 21 out of 22 course objectives. Qualitative analysis revealed three key themes: learning environment, faculty engagement and collegiality. The main challenge to executing the course was procuring adequate faculty, material and facility resources. REFLECTION: This simulation-based, resource-heavy transition course achieved its educational objectives and provided a safe, supportive learning environment for practicing and refining clinical skills.

An observational study of an approach to accommodate a fourth-year to third-year neurology clerkship curricular transition.

Background: Curricular transformation can result in bulges in students' clinical placements.Objective: To report on learner outcomes associated with a competency-based opt-out approach for a required 4th-year neurology clerkship.Methods and Study Design: During Oregon Health & Science University's recent undergraduate medical education curricular transformation, a 4-week required neurology clerkship transitioned from the fourth-year to the third-year in academic year 2016-17. Because this would have resulted in the neurology clerkship accommodating double enrollment for an entire academic year, 4th year medical students from the prior curriculum (graduating class of 2017) were offered the option of opting-out of the required neurology clerkship if they demonstrated competency by passing the USA National Board of Medical Examiners (US-NBME) clinical neurology subject examination and completing a neurology faculty-observed history and complete neurological examination.Results: Fifty-seven of 133 fourth-year students (42.9%) chose to complete the required neurology clerkship with 77 (57.9%) choosing to opt-out. All opt-out students passed the neurological exam assessment and scored similarly to the students who took the clerkship (US-NBME Neurology Subject Exam mean raw score in the opt-out group 76.9 vs, 77.6; p = 0.61). Students grades did not differ. Students who opted-out tended to pursue surgical careers (e.g., general surgery -10.8% opted-out vs 0% clerkship, OB/GYN - 6.8% opted-out vs 0% clerkship, orthopedic surgery 5.4% opted-out vs 0% clerkship) where those who took the clerkship tended to choose medical residency training disciplines (family medicine -16.1% clerkship vs 10.8% opting-out; internal medicine - 32.1% clerkship vs 14.9% opting-out; psychiatry 10.7% clerkship vs 2.7% opting-out (p = 0.042)Conclusion: While undertaking the neurology clerkship would have been the desired approach, students appear not to have been harmed by the opt-out approach regarding performance on the US-NBME clinical neurology subject exam. Choices regarding opting-out versus taking the neurology clerkship appear to be associated with career choice.