Preclerkship assessment of clinical skills and clinical reasoning: the longitudinal impact on student performance.

Abstract

Many medical schools across the United States are undergoing curriculum reform designed, in part, to integrate basic sciences and clinical skills. Evidence has suggested that preclerkship courses in clinical skills and clinical reasoning are predictive of student performance on the clerkship. We hypothesized that a combination of outcome measures from preclerkship clinical skills and clinical reasoning courses (Objective Structured Clinical Examination scores, preceptor evaluations, National Board of Medical Examiners subject examination scores, and small group participation grades) would be correlated to performance in internship (program director [PD]evaluation form at end of first postgraduate year). Outcome measures from preclerkship clinical skills and clinical reasoning courses and PD evaluation forms from 514 medical students graduating between 2009 and 2011 were analyzed in a multiple linear regression model. Preclerkship clinical skills and clinical reasoning outcome measures were significant contributors to the linear regression model and were able to explain 13.9% of the variance in expertise and 7.6% of the variance in professionalism as measured by the PD evaluation form. Clinical skills and clinical reasoning courses during the preclerkship period explained a significant amount of performance at the graduate medical education level. Our data suggest that these courses provide valuable information regarding student abilities in internship. Early recognition of struggling students may provide an opportunity to break a cycle of poor performance that can persist into residency training.