Abstract
Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. With the graduating class of 2017, A.T. Still University's School of Osteopathic Medicine in Arizona (ATSU-SOMA) began requiring additional online curricula for all clerkship courses. To determine whether third year and fourth year students receiving ATSU-SOMA's online curricula during core clerkships performed better overall on national standardized examinations than students from previous years who had not received the curricula, and whether scores from online coursework correlated with outcomes on standardized examinations as possible early predictors of success. This retrospective cohort study analyzed existing data (demographics and assessments) from ATSU-SOMA classes of 2017-2020 (curriculum group) and 2014-2016 (precurriculum group). The effect of the curriculum on national standardized examinations (Comprehensive OsteopathicMedical Achievement Test [COMAT] and Comprehensive Osteopathic Medical Licensing Examination of the United States [COMLEX-USA]) was estimated using augmented inverse probability weighting (AIPW). Correlations between assignment scores and national standardized examinations were estimated using linear regression models. The curriculum group had 405 students with a mean (standard deviation [SD]) age of 25.7 (±3.1) years. Two hundred and fifteen (53.1%) students in the curriculum group were female and 190 (46.9%) were male. The precurriculum group had 308 students (mean±SD age, 26.4±4.2 years; 157 [51.0%] male; 151 [49.0%] female). The online curriculum group had higher COMAT clinical subject exam scores in obstetrics and gynecology, osteopathic principles and practice (OPP), psychiatry, and surgery (all p≤0.04), as well as higher COMLEX-USA Level 2-Cognitive Evaluation (CE) family medicine and OPP subscores (both p≤0.03). The curriculum group had a 9.4 point increase in mean total COMLEX-USA Level 2-CE score (p=0.08). No effect was found for the curriculum overall on COMAT mean or COMLEX-USA Level 2-Performance Evaluation scores (all p≥0.11). Total coursework scores in each core clerkship, excluding pediatrics, were correlated with COMAT mean score (all adjusted p≤0.03). Mean scores for five of the seven assignment types in core clerkships, excluding evidence based medicine types, were positively correlated with COMAT mean scores (all adjusted p≤0.049). All assignment types correlated with COMLEX-USA Level 2-CE total score (alladjusted p≤0.04), except interprofessional education (IPE). Results from this study of 713 students from ATSU-SOMA suggested that our online curriculum supplemented clinic based learning during clerkship courses and improved student outcomes on national standardized examinations.
Highlights
Context: Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education
Data were grouped by year of graduation, which determined participation in the online curricula or nonparticipation; data were excluded for five students who appeared in both groups
Standardized differences without inverse probability weighting (IPW) were found for age, race, undergraduate nonscience GPA, MCAT scores, number of times the COMLEX-USA Level 1 was taken before passing, subject specific COMLEX-USA Level 1 scores, and time to graduate
Summary
Context: Many medical schools have a distributed model for clinical clerkship education, challenging our ability to determine student gaps during clinical education. Another study from 2015 [2] reporting the results of blended online learning in a surgery clerkship for 129 students at Johns Hopkins University showed no statistically significant improvement in outcomes on the National Board of Medical Examiners (NBME) surgery subject exam, and analysis of scores for one term of the study year revealed statistically significant lower scores in the blended online learning group. One of our own prior studies [11] evaluated required online coursework scores for 105 students in a family medicine (FM) clerkship and showed positive correlations with outcomes on National Board of Osteopathic Medical Examiners Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 2-Cognitive Evaluation (CE) examination and the COMAT FM examination [11]. This course had no daily clinic based component with a preceptor, but required osteopathic manipulative treatment (OMT) practice activity at least once each semester
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