Pre-clerkship clinical skills and clinical reasoning course performance: Explaining the variance in clerkship performance : Pre-clerkship predictors of clerkship variance.

Jeffrey S Larochelle,Ting Dong,Steven J Durning

doi:10.1007/s40037-016-0287-z

Abstract

Introduction: Evidence suggests that pre-clerkship courses in clinical skills and clinical reasoning positively impact student performance on the clerkship. Given the increasing emphasis on reducing diagnostic reasoning errors, it is very important to develop this critical area of medical education. An integrated approach between clinical skills and clinical reasoning courses may better predict struggling learners, and better allocate scarce resources to remediate these learners before the clerkship. Methods: Pre-clerkship and clerkship outcome measures from 514 medical students graduating between 2009 and 2011were analyzed in a multiple linear regression model. Results: Learners with poor performances on integrated pre-clerkship outcome measures had a relative risk of 6.96 and 5.85 for poor performance on National Board of Medical Examiners (NBME) subject exams and clerkship performance, respectively, and explained 22 % of the variance in clerkship NBME subject exam scores and 20.2 % of the variance in clerkship grades. Discussion: Pre-clerkship outcome measures from clinical skills and clinical reasoning courses explained a significant amount of clerkship performance beyond baseline academic ability. These courses provide valuable information regarding student abilities, and may serve as an early indicator for students requiring remediation. Conclusions: Integrating pre-clerkship outcome measures may be an important aspect of ensuring the validity of this information as the pre-clerkship curriculum becomes compressed, and may serve as the basis for identifying students in need of clinical skills remediation.

Highlights

Evidence suggests that pre-clerkship courses in clinical skills and clinical reasoning positively impact student performance on the clerkship
To examine the students’ Introduction to Clinical Medicine (ICM) and Introduction to Clinical Reasoning (ICR) course assessments predictive power on average clerkship National Board of Medical Examiners (NBME) subject exam score as well as average final grade across all six clerkships, we developed a multiple linear regression model
The standardized coefficient, which represents the relative strength of the predictors in the model, of 0.53 for the Introduction to Clinical Diagnosis (ICD) NBME subject exam indicates a fairly large effect size of 1.25 on the clerkship NBME subject exam score

Summary

Introduction

Evidence suggests that pre-clerkship courses in clinical skills and clinical reasoning positively impact student performance on the clerkship. Discussion: Pre-clerkship outcome measures from clinical skills and clinical reasoning courses explained a significant amount of clerkship performance beyond baseline academic ability. These courses provide valuable information regarding student abilities, and may serve as an early indicator for students requiring remediation. Many medical schools in the United States continue to adhere to a predominantly ‘Flexnerian’ model (two years of basic science courses followed by two years of clinical rotations), several medical schools are undergoing significant curriculum reforms aimed at integrating basic sciences with clinical skills teaching while often reducing the pre-clerkship period to facilitate an early transition to the clinical clerkships [1]. Some have suggested that a combination of pre-clerkship assessments may better explain the variance in a student’s clinical abilities on the clerkship [3]

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Results

Discussion

Conclusion