Standardized Patient Assessment of Ambulatory Clerks: Effect of Timing and Order of the Clerkship

Abstract

Background: A standardized patient examination may assess unique learning in an ambulatory clerkship but, as with written tests, may be affected by student maturation. Purpose: To explore the effect of timing and order of a medicine ambulatory clerkship on student performance of a standardized patient examination (SPE). Methods: All students rotating through an ambulatory medicine clerkship in 1 academic year completed an SPE designed to reflect specific learning objectives of the clerkship as well as nonclerkship case content. Students were grouped according to prior inpatient clerkship experience. Results: When compared to students with only ambulatory experience, students with both inpatient and ambulatory experiences in internal medicine did not perform better on the ambulatory cases of the SPE but did perform better on nonclerkship cases. Performance on the SPE was not affected by month of training. At completion of the inpatient clerkship, students with prior ambulatory experience did not perform better than students with inpatient-only experience on the National Board of Medical Examiners Medicine Subject Examination. Conclusions: The SPE is an appropriate assessment tool for the ambulatory clerkship when case content is linked to learning objectives of the clerkship. Unlike other knowledge-based assessments, the SPE is not affected by student maturation.