Clerkship Performance Research Articles

Effects of Recorded versus Live Teleconference Didactic Lectures on Medical Student Performance in the Surgery Clerkship

OBJECTIVEDue to the COVID-19 pandemic, numerous institutions converted medical education didactics to electronic formats including both live teleconference didactics and recorded faculty lectures. This study aims to compare the effect of recorded versus live teleconference didactic lectures on medical student examination scores during the surgery clerkship.DESIGNMedical students completing the Surgery Clerkship received a weekly series of didactic lectures taught by faculty via a teleconference (2020-2021 academic year) or recorded format (2021-2022 academic year). Performance outcomes included weekly quizzes, National Board of Medical Examiners (NBME) Surgery Shelf Exam, and clerkship Objective Structured Clinical Examination (OSCE) scores.SETTINGUniversity of Miami Miller School of Medicine.PARTICIPANTSAll second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over two academic years (n = 312).RESULTSStudents who received live teleconference lectures (n = 156) demonstrated higher average scores on weekly quizzes (89%) and the NBME shelf exam (76%) compared to those receiving recorded lectures (n = 156; 71% quiz, 70% shelf exam), both p < 0.001. There was a significant association with performance in the highest quartile (Q1) of weekly quiz scores and receiving live lectures (40% vs. recorded lectures 1%, p < 0.001). Comparing only MS3 students, mean weekly quiz scores and Q1 achievement were significantly higher (both p < 0.001) in the teleconference cohort with no significant difference in NBME shelf exam performance (p = 0.971). No difference in OSCE performance was observed between groups.CONCLUSIONThese results suggest that synchronous teleconferences may be more effective than recorded lectures for achieving institutional learning objectives on the surgery clerkship without any negative impact on NBME shelf exam or clinical evaluation parameters. This information should be used to inform future institutional clerkship design and educational initiatives.

Matching into Orthopedic Surgery in the U.S. Navy: A Review of Applicant Selection Criteria.

The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants. Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated. Navy leadership unanimously expressed that clerkship performance at the individual program director's institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance. Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.

Exploring the impact of postponing core clerkships on future performance

ABSTRACT Despite the many clerkship models of medical education, all can be considered a form of experiential learning. Experiential learning is a complex pedagogical approach involving the development of cognitive skills in an environment with a unique culture with multiple stakeholders, which may impact learner motivation, confidence, and other noncognitive drivers of success. Students may delay the transition to the clerkship year for myriad reasons, and the intricate nature of experiential learning suggested this may impact student performance. This retrospective, observational study investigated the impact of clerkship postponement by measuring subsequent clerkship performance. Pre-clerkship and third-year clerkship performance were analyzed for three cohorts of students (classes of 2018, 2019, and 2020, N = 274) where students had the option to delay the start of their clerkship year. A mixed analysis of variance (ANOVA) and paired t-tests were conducted to compare academic performance over time among students who did and did not delay. Across three cohorts of students, 12% delayed the start of the clerkship year (N = 33). Regardless of prior academic performance, these students experienced a significant reduction in clerkship grades compared to their non-delaying peers. Delaying the start of the clerkship year may have negative durable effects on future academic performance. This information should be kept in mind for student advisement.

Gender differences in repeat-year experience, clinical clerkship performance, and related examinations in Japanese medical students.

While the number of female medical students is increasing in Japan, gender differences in medical school performance have not been studied extensively. This study aimed to compare gender differences in repeat-year experience, Clinical Clerkship (CC) performance, and related examinations in Japanese medical students. We retrospectively analyzed the number of repeat-year students and years to graduation for male and female medical students, and assessed gender differences in performance on computer-based testing (CBT) before CC, CC as evaluated by clinical teachers, the CC integrative test, and the graduation examination in 2018-2020 graduates from our medical school. Subgroup analyses excluding repeat-year students were also performed. From 2018 to 2020, 328 medical students graduated from our medical school. There were significantly fewer repeat-year female students compared to male students (P = .010), and the average number of years to graduate was significantly higher for male students than female students (P < .001). Female students showed higher scores and performance in all integrative tests and CC (P < .05, each). In analysis excluding repeat-year students, there were no significant gender difference in performance on the CBT, and CC integrative test, although female students significantly outperformed male students on the CC and graduation examination. Female medical students had a fewer number of repeat-years and performed better in the CC and graduation examination compared to their male counterparts.

Step 1 is Pass/Fail, Now What? Can Clinical Clerkship Grades be Used as a Reliable Metric to Screen General Surgery Residency Applicants?

IntroductionFor decades, the three-digit United States Medical Licensing Exam Step 1 score has been used to competitively evaluate and compare candidates during the residency application process. Starting in 2022, however, all Step 1 scores will be converted to pass/fail. A different quantitative measure will likely gain importance in its stead, one such being clerkship performance grades. This study aims to determine the consistency of class rank and distribution of clerkship grades reported by medical schools for applicants to a general surgery program. MethodsCandidates’ Medical Student Performance Evaluation letters from 141 unique US allopathic medical schools were reviewed for student overall class rank, the number of grading tiers in each clerkship, and the percent achieving honors criteria in each clerkship from the 2020 application cycle. Comparative analysis was performed by region and medical school prestige. ResultsMost medical schools rank students using a four-tier system (e.g., fail, pass, high pass, and honors). A third of schools do not provide an overall class rank of students (34.7% of schools); this was most prevalent in the Northeast and Western regions. Schools in the Central US more often rank their students in five tiers compared to the South (P < 0.01). The percent of students that achieve the highest grading tier varies across the core clerkships (mean 37.1%, range 6.5%-78%); an average of 34.5% of students meet the highest honors tier in their Surgery clerkship. Students at US News and World Report Top 20 medical schools are more likely to receive the highest honors tier, across all core clerkships and overall class rank, than students at schools outside the Top 20 (P < 0.05). ConclusionsIn the absence of the United States Medical Licensing Exam Step 1 score, the variability in clerkship grading tiers and overall class rank will likely pose a challenge to residency programs’ ability to stratify desirable applicants. Further transparency and standardization may be required to compare students objectively and fairly from medical schools across the country.

Effect of station format on the psychometric properties of Multiple Mini Interviews.

Given the widespread use of Multiple Mini Interviews (MMIs), their impact on the selection of candidates and the considerable resources invested in preparing and administering them, it is essential to ensure their quality. Given the variety of station formats used and the degree to which that factor resides in the control of training programmes that we know so little about, format's effect on MMI quality is a considerable oversight. This study assessed the effect of two popular station formats (interview vs. role-play) on the psychometric properties of MMIs. We analysed candidate data from the first 8 years of the Integrated French MMIs (IF-MMI) (2010-2017, n = 11 761 applicants), an MMI organised yearly by three francophone universities and administered at four testing sites located in two Canadian provinces. There were 84 role-play and 96 interview stations administered, totalling 180 stations. Mixed design analyses of variance (ANOVAs) were used to test the effect of station format on candidates' scores and stations' discrimination. Cronbach's alpha coefficients for interview and role-play stations were also compared. Predictive validity of both station formats was estimated with a mixed multiple linear regression model testing the relation between interview and role-play scores with average clerkship performance for those who gained entry to medical school (n = 462). Role-play stations (M = 20.67, standard deviation [SD] = 3.38) had a slightly lower mean score than interview stations (M = 21.36, SD = 3.08), p < 0.01, Cohen's d = 0.2. The correlation between role-play and interview stations scores was r = 0.5 (p < 0.01). Discrimination coefficients, Cronbach's alpha and predictive validity statistics did not vary by station format. Interview and role-play stations have comparable psychometric properties, suggesting format to be interchangeable. Programmes should select station format based on match to the personal qualities for which they are trying to select.

Effects of Organ System Courses of the First Two Years of Medical School on the Performance of the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 2-Cognitive Evaluation

Objectives: The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 2-Cognitive Evaluation (CE) is a board examination that medical students usually take in the third or fourth year of medical school. A few researchers have investigated the prediction of COMLEX Level 2-CE scores based on the performance in third-year clerkships. However, given how close the clerkships are to the board exam, this type of prediction is too late for students to have adequate time to get assistance to prepare for COMLEX Level 2-CE. We aimed to investigate the predictive value of each organ system course during the first two years in predicting COMLEX Level 2-CE performance. Our findings will help students at risk focus on important basic and clinical sciences much earlier before preparing for COMLEX Level 2-CE.Methods: Academic data from students enrolled at Rocky Vista University College of Osteopathic Medicine from 2011 to 2017 were retrieved. Data included the Medical College Admission Test (MCAT) scores, course grades in the first two years of medical school, COMLEX Level 1 scores, and COMLEX Level 2-CE scores. Pearson correlation coefficients, a multiple linear regression model, and a backward stepwise regression model were generated for analysis.Results: The highest correlation with COMLEX Level 2-CE scores was the COMLEX Level 1 score, followed by the performances in the third-semester Cardiovascular System II (CV II) and Renal System II (REN II) courses. Multiple linear regression and backward stepwise regression predictive models found that scores on third-semester CV II and Principles of Clinical Medicine III (PCM III) were the most significant predictors of performance on Level 2-CE. Both models explained 46% of the variance in COMLEX Level 2-CE scores.Conclusions: Performances in third-semester courses are the most important predictors of COMLEX Level 2-CE scores.

Gauging the effects of COVID-related changes to the medical student surgical clerkship experience: a mixed-methods study.

PurposeThis study sought to understand the medical student experience on the restructured surgical clerkship during the COVID-era to provide guidance for future scenarios affecting student participation in clinical activities.MethodsMedical students completing an anonymous 70-question survey at the conclusion of their surgical clerkship from June 2019 to October 2020 were divided into 2 cohorts: students completing their clerkship prior to March 2020 and after June 2020. Quantitative assessment was performed to evaluate the clerkship performance and perceptions. Resulting findings were used to construct an interview guide and conduct semi-structured interviews.ResultsFifty-nine medical students rotated through the surgical clerkship prior to COVID and 23 during the COVID-era. No differences in perception of the surgical clerkship, participation in essential activities, or shelf examination scores were found. Students completing their clerkship during the COVID-era reported a lower perception of interaction and professional relationships with attending and resident surgeons (p = 0.03). Qualitatively, students completing their clerkship during the COVID-era struggled to balance clinical experiences with personal wellness and noted that building relationships with faculty was substantially more difficult.ConclusionsThere does not appear to be a difference in the level of participation in essential clerkship activities nor a diminished perception of learning between students completing their surgical clerkship before or during the pandemic. However, there does appear to be a difference in the relationships formed between students and attending surgeons. Altered didactic structures and apprenticeship-type rotations may help mitigate such effects.Supplementary InformationThe online version contains supplementary material available at 10.1007/s44186-022-00015-2.

Early Pre-clerkship Clinical Skills Assessments Predict Clerkship Performance.

IntroductionAssessment of medical students’ clinical skills (CS) remains a challenge. Little is known about early predictors of future CS performance. This study examines the relationship between students’ pre-clerkship clinical skills (PCCS) performance and year 3 clerkship performance measures.MethodsThe authors performed a retrospective analysis of four medical student cohorts who matriculated between 2014 and 2017 and participated in a longitudinal pre-clerkship CS curriculum. A total of 440 students were included in the analyses. Students’ clinical skills were assessed through a series of PCCS exams, each consisting of a single standardized patient encounter. First-year PCCS exams assessed history taking, physical examination, professionalism, and communication skills; second-year PCCS exams also assessed clinical documentation and clinical reasoning skills. Evaluators assigned a grade of “satisfactory,” “borderline,” or “unsatisfactory” for each skill set. Regression analyses compared year 3 performance outcomes between students with one or more “unsatisfactory” or “borderline” PCCS skill set grades and students assessed as “satisfactory” for all PCCS skill set assessments.ResultsThirty-two percent (n = 140) of the 440 students had at least one borderline or unsatisfactory (US) PCCS skill set grade. These students performed significantly worse on year 3 National Board of Medical Examiner subject exams, workplace-based clinical performance evaluations, and overall year 3 performance compared to students who passed all PCCS exam components. In addition, a higher percentage of students with PCCS performance deficiencies failed the United States Medical Licensing Examination Step 2 CS exam on the first attempt versus students who passed all PCCS exam components.ConclusionsPCCS exam performance at our institution aligned with future student performance on multiple year 3 clerkship outcome measures. This pre-clerkship performance data can be used to identify at-risk students who would benefit from additional resources to achieve competency in the clerkship environment and future medical training.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40670-022-01519-8.

The importance of personality traits for predicting clinical clerkship grades and USMLE scores

Background: Important aspects of medical school success are thought to rely on non-cognitive attributes such as personality traits. Methods: In a sample of medical students who completed their 3rd-year clerkships, the current study examined the impact of personality traits on performance on four measures of 3rd-year clerkship grades and United States Medical Licensing Examination (USMLE) Step 2CK (Clinical Knowledge) scores. Results: We found that specific personality traits, including conscientiousness, achievement-striving, morality, and self-efficacy predicted multiple outcome measures, including Step 2CK performance. However, while we observed a clear link between personality and success during the 3rd year, we also found that Step 1 scores, not specific or grouped personality traits, best predicted all measures of clerkship performance except clerkship evaluations and, as expected, best predicted Step 2CK performance. Additionally, we created a composite personality profile for our sample by averaging the high and low scores of the Big Five personality trait scales and their subscales. However, this personality composite, which included the traits agreeableness, cooperation, Conscientiousness, and cautiousness, did not predict any of our outcome measures. Conclusions: These findings indicate that personality traits individually and in combination predict 3rd year medical school success, especially when performance may rely less on intellectual prowess, and more on personality factors. Importantly, however, Step 1 scores were usually much better predictors not only of Step 2CK and shelf exam performance, but even overall clerkship grades and Objective Structured Clinical Examination (OSCE) performance. We hope these results can be used to help clerkship directors and faculty understand that personality factors impact medical school performance and that they should be considered when evaluating the more non-cognitive aspects of student achievement.

Residency Program Director Perceptions of Resident Performance Between Graduates of Medical Schools With Pass/Fail Versus Tiered Grading System for Clinical Clerkships: A Meta-Analysis.

Purpose: The variability and imprecision of clerkship grading raise concerns for program directors (PDs) during applicant selection. 1 Although the majority of medical schools have adopted pass/fail (P/F) preclinical grading, only 12 schools formally use P/F grading for clerkships. 2 Additionally, per Liaison Committee on Medical Education recommendations, events such as Hurricane Katrina and the COVID-19 pandemic have led additional schools to adopt P/F clerkship grading temporarily. 3 Moreover, the rise in studies describing student- and institutional-level disparities in clerkship grading has tasked medical education personnel with weighing the fairness and risk of disparities as well as the potential benefits of tiered grading. 1,4 With the continued paucity of literature examining P/F grading in core clerkships, 5 we conducted a meta-analysis of studies comparing PDs’ perceptions of residency performance among residents from schools using P/F versus tiered clerkship grading systems. Approach/Methods: Embase, PubMed, and Scopus were searched since inception through October 2020, and hand searches were performed of the retrieved reference lists. No study or language restrictions were applied. Studies exploring P/F clerkship in the context of a cohort of PD assessments were included, and the CLARITY risk of bias was used. Reviewers assessed study characteristics, overall resident performance, learning ability, work habits, work products, educational assessments, and PD’s personal evaluation (worse: 0 to best: 100), and were assessed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. To account for different survey and grading metrics, adjusted standard difference in means were used. Main outcomes and measures were program director ratings of residents from U.S. medical schools using tiered versus P/F clerkship grading. Results/Outcomes: From 4,931 studies screened, we identified 6 eligible studies (3 cohort, 3 surveys; 6 low risk of bias) with 2,118 participants. From 31 accredited medical specialties, 7 specialties were represented with a median response rate of 81.0% (95% CI, 49.0–100.0). Reported as means, there was no difference in PD preference for residents from P/F or tiered grading system throughout residency training (37.0% Tiered; 95% CI, 0–100, P > .05). Adjusted scaled scores utilizing mean difference from an equal variance model from PDs showed overall performance (5.5; 95% CI, –1.9 to 12.9), learning ability (2.7; 95% CI, 0–5.4), work habits (2.9; 95% CI, 0–5.8), personal evaluations (–1.6; 95% CI, –3.8 to 0.6) and educational evaluation (1.7; 95% CI, –0.8 to 4.3) of residents from tiered clerkship grading systems were not statistically significant (P > .05) from P/F residents. However, there was a difference in work products produced (6.8; 95% CI, 1.4–12.2, P < .0001). Meta-regression standard difference in means revealed that there is no difference in tiered applicant’s overall performance in residency compared with P/F applicants (0.0001 fixed, P = .98; –0.0047 random, P = .81) Discussion: Clerkship performance has often been used as a metric to assess medical student preparedness for residency. 1,2 While PDs reported that residents from medical schools using P/F clerkship gradings tended to perform slightly lower on average, these results were not statistically significant. In addition, PDs did not generally prefer applicants from tiered medical schools. Given the continued expansion of P/F grading in medical school curricula, our findings allow for early discussion regarding the implications of P/F clerkship grading and its anticipated reception by stakeholders. Significance: In our cohort, there appears to be no perceived difference in resident performance based on clerkship grading system. This study provides further impetus for discussion of wider adoption of P/F grading in clinical clerkships.

Improving Student Understanding of Clerkship Expectations With an Online, Interactive Frame-of-Reference Training Module.

Purpose: Assessment of medical students during clerkships is largely driven by clinical performance ratings, but many students perceive clinical evaluations to be “unfair” and call for more training of evaluators. 1 Limitations in self-assessment may contribute to this perception, 2 and frame-of-reference training may improve students’ ability to recognize different levels of performance. 3 The objective of this study was to determine if an online, frame-of-reference training module can improve students’ understanding of clerkship expectations for clinical performance in the medicine clerkship. Methods: Core faculty in the medicine clerkship developed multiple case presentations that demonstrated different levels of performance in the Reporter, Interpreter, Manager, and Educator (RIME) components of our clerkship evaluation form. The case presentations were revised in an iterative fashion to reach a consensus in defining each of the case presentations as below, at, or exceeding expectations for clerkship students. Using these presentations, an online, interactive frame-of-reference training tool was developed where students, before starting clerkships, rated a set of case presentations, compared their ratings with those determined by core faculty (correct ratings), and received feedback about why a given presentation merits a particular rating. At the start of the clerkship, students completed another training module with a new set of case presentations, either remotely on their own (odd-numbered clerkship blocks) or in-person with group discussion facilitated by the clerkship director (even-numbered blocks). We used chi-square tests to compare proportion of students choosing correct ratings on case presentations at baseline versus in-clerkship training and to compare student responses between remote versus in-person training groups with an end-of-clerkship survey on the effect of training on their understanding of clerkship expectations. Results: All rising third-year students (N = 177) completed baseline training, and 140 students (100% enrolled in blocks 1–6 of medicine clerkship) completed the in-clerkship training. Students enrolled in blocks 7 and 8 were excluded due to COVID-related cancelations/rescheduling of clinical rotations. Overall, the percentage of cases answered correctly at baseline was 64.8% and improved to 74.5% at in-clerkship training (P < .001). In looking at individual domains of RIME, improvements were seen for all domains except interpreter:reporter 55.7% to 67.6% (P = .002), interpreter 74.3% to 62.8% (P = .001), manager 68.0% to 82.5% (P < .0001), and educator 62.5% to 85.1% (P < .0001). The pattern of improvement was not statistically different between remote versus in-person training groups. The majority of students agreed or strongly agreed that the online training improved their understanding of clerkship expectations (66.0% of remote versus 75.0% of in-person training groups, P = .604). Discussion: In this study of frame-of-reference training for students, we found a significant increase in proportion of cases rated correctly from baseline to in-clerkship training. The lack of improvement in the interpreter domain likely reflects the challenges posed by clinical reasoning required for interpreter, which is a component of RIME students are most uncomfortable with during preclinical years, and a skill most heavily emphasized in the medicine clerkship. Repeating the training module at the end of the medicine clerkship may have shown different results. Our finding that student perception regarding usefulness of the training was similar between remote versus in-person training is worth noting because faculty time and effort, which are often seen as barriers to many educational efforts, in this case did not significantly improve effectiveness of training. Significance: While much of the effort to improve clinical evaluations has focused on rater training, this study assessed whether training students can improve their understanding of clerkship expectations. Our findings show that a brief, online, frame-of-reference training tool can improve student understanding of different levels of clinical performance. Acknowledgments: The authors thank their faculty and medical students for their contribution and participation in this study.

What Does Honors Mean? National Analysis of Medical School Clinical Clerkship Grading

Medical Student Performance Evaluation (MSPE) letters provide critical comparative information about clerkship performance, and are a crucial part of the surgical residency application. The elimination of USMLE Step 1 numeric reporting increases the importance of transparency, standardization, and accessibility of comparative information reported on the MSPE. The objective of our study was to measure the variability in clerkship grade reporting on the MSPE from US medical schools, particularly focusing on the highest (honors) grades. We identified representative MSPE letters from US medical schools and recorded the percentage of honors for 5 core clerkships. We grouped medical schools according to medical school rankings, geographic region, and number of grading categories RESULTS: Of 122 medical schools, 106 schools (87%) reported their grading scheme and percent honors. The most commonly used grading scheme was a 4-tier system (51/122; 42%). The percentage of honors was highly variable (from 1-91%) and did not vary by region. However, schools in the top 20 research ranking were less likely to report grade comparisons (30% vs. 10%), and more likely to award more students honors in 4 of the 5 clerkships. Schools in the top 20 primary care ranking were more likely to award more honors in the medicine clerkship. There is significant variability in the number of grading tiers used and the percentage of students awarded honors across US medical schools. Factors that correlated to higher grades included schools with higher rankings, and higher ranked schools were less likely to report comparative information at all.

The relationship between attendance and academic performance of undergraduate medical students during surgical clerkship

BackgroundThe current study aimed to evaluate the previously unexplored correlation between undergraduate medical students’ attendance during their surgical clerkship and their academic performance. It also aimed to explore any difference in the attendance rate between male and female students and whether this difference, if present, affects the academic performance.MethodsA retrospective descriptive cross-sectional study has been conducted on 331 undergraduate medical students during their surgical clerkships at the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU), Bahrain from September 2018 to June 2020.ResultsThere was a positive statistically significant correlation between students’ attendance during surgical clerkship and academic performance (r = 0.360, P < 0.01). Mean attendance rate was greater in each increasing category of academic performance: 47.95% in the weak category (less than 65%, n = 42), 57.62% in the good performance category (65% to less than 75%, n = 108), 67.82% in the very good performance category (75% to less than 85%, n = 126), 83.16% in the excellent performance category (85% and above, n = 55). The mean attendance rate of male students was 59.76% (SD = 25.73), compared to 66.92% (SD = 24.30) in the female students. T-test indicated that the difference between the mean attendance of the two groups of the students (male, female) was statistically significant (t = 2.483, p < 0.05). On the other hand, the difference between the mean academic performance for the two groups of students, male & female, (t = 0.284, p = 0.777) was not statistically significant.ConclusionsOur study showed a significant relationship between undergraduate medical students’ attendance during their surgical clerkship and their academic performance. Further studies are needed to stratify this correlation according to clinical and theoretical teaching activities. No significant difference was observed in academic performance between female and male students.

Profiles for Success: Examining the Relationship between Student Profiles and Clerkship Performance Using Latent Profile Analysis

Phenomenon Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. Approach In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students’ clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. Findings We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) “average” group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. Insights The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment.

The use of EPA assessments in decision-making: Do supervision ratings correlate with other measures of clinical performance?

Background Entrustable professional activities (EPAs) have been introduced as a framework for teaching and assessment in competency-based educational programs. With growing use, has come a call to examine the validity of EPA assessments. We sought to explore the correlation of EPA assessments with other clinical performance measures to support use of supervision ratings in decisions about medical students’ curricular progression. Methods Spearman rank coefficients were used to determine correlation of supervision ratings from EPA assessments with scores on clerkship evaluations and performance on an end-of-clerkship-year Objective Structured Clinical Examination (CPX). Results Both overall clinical evaluation items score (rho 0.40; n = 166) and CPX patient encounter domain score (rho 0.31; n = 149) showed significant correlation with students’ overall mean EPA supervision rating during the clerkship year. There was significant correlation between mean supervision rating for EPA assessments of history, exam, note, and oral presentation skills with scores for these skills on clerkship evaluations; less so on the CPX. Conclusions Correlation of EPA supervision ratings with commonly used clinical performance measures offers support for their use in undergraduate medical education. Data supporting the validity of EPA assessments promotes stakeholders’ acceptance of their use in summative decisions about students’ readiness for increased patient care responsibility.

Gender Disparity in Evaluation of Internal Medicine Clerkship Performance

Women studying medicine currently equal men in number, but evidence suggests that men and women might not be evaluated equally throughout their education. To examine whether there are differences associated with gender in either objective or subjective evaluations of medical students in an internal medicine clerkship. This single-center retrospective cohort study evaluated data from 277 third-year medical students completing internal medicine clerkships in the 2017 to 2018 academic year at an academic hospital and its affiliates in Pennsylvania. Data were analyzed from September to November 2020. Gender, presumed based on pronouns used in evaluations. Likert scale evaluations of clinical skills, standardized examination scores, and written evaluations were analyzed. Univariate and multivariate linear regression were used to observe trends in measures. Word embeddings were analyzed for narrative evaluations. Analyses of 277 third-year medical students completing an internal medicine clerkship (140 women [51%] with a mean [SD] age of 25.5 [2.3] years and 137 [49%] presumed men with a mean [SD] age of 25.9 [2.7] years) detected no difference in final grade distribution. However, women outperformed men in 5 of 8 domains of clinical performance, including patient interaction (difference, 0.07 [95% CI, 0.04-0.13]), growth mindset (difference, 0.08 [95% CI, 0.01-0.11]), communication (difference, 0.05 [95% CI, 0-0.12]), compassion (difference, 0.125 [95% CI, 0.03-0.11]), and professionalism (difference, 0.07 [95% CI, 0-0.11]). With no difference in examination scores or subjective knowledge evaluation, there was a positive correlation between these variables for both genders (women: r = 0.35; men: r = 0.26) but different elevations for the line of best fit (P < .001). Multivariate regression analyses revealed associations between final grade and patient interaction (women: coefficient, 6.64 [95% CI, 2.16-11.12]; P = .004; men: coefficient, 7.11 [95% CI, 2.94-11.28]; P < .001), subjective knowledge evaluation (women: coefficient, 6.66 [95% CI, 3.87-9.45]; P < .001; men: coefficient, 5.45 [95% CI, 2.43-8.43]; P < .001), reported time spent with the student (women: coefficient, 5.35 [95% CI, 2.62-8.08]; P < .001; men: coefficient, 3.65 [95% CI, 0.83-6.47]; P = .01), and communication (women: coefficient, 6.32 [95% CI, 3.12-9.51]; P < .001; men: coefficient, 4.21 [95% CI, 0.92-7.49]; P = .01). The model based on the men's data also included growth mindset as a significant variable (coefficient, 4.09 [95% CI, 0.67-7.50]; P = .02). For narrative evaluations, words in context with "he or him" and "she or her" differed, with agentic terms used in descriptions of men and personality descriptors used more often for women. Despite no difference in final grade, women scored higher than men on various domains of clinical performance, and performance in these domains was associated with evaluators' suggested final grade. The content of narrative evaluations significantly differed by student gender. This work supports the hypothesis that how students are evaluated in clinical clerkships is associated with gender.

Frame-of-Reference Training for Students: Promoting a Shared Mental Model for Clerkship Performance with an Online, Interactive Training Module.

Frame-of-Reference Training for Students: Promoting a Shared Mental Model for Clerkship Performance with an Online, Interactive Training Module.

Medical Student Personality Traits and Clinical Grades in the Internal Medicine Clerkship.

Third year clerkship grades include subjective evaluations. The purpose of this study is to identify if personality traits and self-esteem predispose students to better clerkship performance. Third-year medical students completed the OCEAN Five Factor Model Personality Test and Rosenberg Self-Esteem Scale. Clerkship grades were matched to survey results. Chi-squared and linear regression analyses assessed the correlation between students' clerkship grades, personality traits, and self-esteem. There was no association between OCEAN personality domains and any component of clerkship grade. In secondary post hoc analysis, students who are "deep thinking" (OR 2.97, 95% CI 1.26-7.01, p = 0.01), "sophisticated" (OR 2.70, 95% CI 1.12-6.50, p = 0.03), and "outgoing" (OR 2.45, 95% CI 1.02-5.89, p = 0.04) were significantly more likely to get an overall clerkship grade of Honors. "Deep thinking" (OR 3.44, 95% CI1.47-8.04, p = 0.004) and "efficient" (OR 2.87, 95% CI 1.12-7.36, p = 0.03) students scored better on shelf exams, while "shy" students scored worse (OR 0.30, 95% CI 0.13-0.69, p = 0.004); "aloof" students received worse clinical scores (OR 0.57, 95% CI 0.37-0.89, p = 0.03), and "rude" (OR 5.08, 95% CI 1.03-24.94, p = 0.03) and "sophisticated" (OR 2.47, 95% CI 1.02-6.00, p = 0.04) students received higher preceptor scores. There was no correlation between self-esteem and clerkship grades. Students with certain personality traits may be predisposed to success during clerkships. Medical educators should be cognizant of biases favoring certain personalities and help students maximize success by recognizing their strengths and identifying gaps.

Development and questionnaire-based evaluation of virtual dental clinic: a serious game for training dental students

ABSTRACT Background The volume of literature about serious gaming in dental education has increased, however, none of the previous studies have developed a serious game for closing the gap between preclinical and clinical training. Objective Virtual Dental Clinic (VDC) is a serious game that was created to help develop clinical reasoning skills in dental students. This study aimed to evaluate VDC as an educational tool and its effectiveness on clinical skill and knowledge gain among clerkship dental students. Methods The following three stages of VDC design and testing were addressed from 2016 to 2020: development, validation, and application. The VDC was developed using Unity game engine. In the validation stage, the content validity was reviewed by five visiting staff; construct validity and face validity were examined by 9 postgraduate-year dentists and 14 clerkship dental students. Concurrent validity and predictive validity were examined by 34 fifth-year dental students during their clerkship from September, 2018 to May, 2019, the associations between VDC experiences, clerkship performance, and the score on a national qualification test were explored. In the application stage, the VDC was set up as a self-learning tool in the Family Dentistry Department from August, 2019, quantitative and qualitative analyses were conducted using the 92 clerkship students’ feedback. Results The VDC showed good validity and a high potential for education in practice. Students who have used VDC received significantly higher scores on qualification test (p = 0.029); the VDC experiences significantly predicted higher performance score on periodontics (p = 0.037) and endodontics (p = 0.040). After the outbreak of COVID-19 pandemic, significantly higher proportion of students confirmed the value of VDC as an assistant tool for learning clinical reasoning (p = 0.019). Conclusions The VDC as an educational tool, and the effectiveness on clinical reasoning skills and knowledge gain among clerkship dental students has been validated and confirmed in this study.