Subject Exam Research Articles

Are Age, Sex, or Race and Ethnicity Associated With Performance on the OBGYN NBME Exam and Clerkship?

We sought to evaluate the association of demographic variables-sex, age, and race/ethnicity-on the OBGYN National Board of Medical Examiners (NBME) subject exam scores and clerkship final grades to identify potential disparities that could impact residency matches. This retrospective study included 1550 students from a single medical school, spanning graduating classes from 2015 to 2024. Statistical analyses were conducted to examine differences in the OBGYN NBME scores and grades as a function of age, sex, ethnicity, and preclerkship performance. Uniformed Services University of Health Sciences PARTICIPANTS: All clerkship level medical students (1550) over a 10 year period. Results indicated that younger students performed better on the OBGYN NBME exam, with a negative correlation between age and NBME scores (r = -.15, p < 0.001). Women outperformed men on the NBME exam (d = 0.23) and had higher final OBGYN grades than men. Analysis by race and ethnicity showed that nonunderrepresented in medicine races and ethnicities (NUIM) scored significantly higher than underrepresented in medicine (UIM) on the NBME exam (d = 0.34). However, when controlling for preclerkship performance, no significant differences were observed between ethnic groups. These findings highlight the need for residency programs to consider demographic influences on standardized test performance. Clerkship directors may need to evaluate grading rubrics and the weight given to NBME scores to ensure fair assessment and support for all students, particularly those from UIM backgrounds. Further research is needed to explore the underlying factors contributing to these disparities and to develop strategies to mitigate them.

Gender Differences in Self-Assessment Among Clerkship Medical Students Despite Equivalent Academic and Clinical Performance.

The authors aimed to determine if medical students' self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators. Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as "below," "at," or "above expected level." Ratings were coded numerically, and statistical analysis was performed using Student's T-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance. Female students (n = 123) rated their performance significantly below male peers (n = 114) in medical knowledge (female - 0.05 vs male 0.13), clinical reasoning (- 0.02 vs 0.06), differential diagnosis (- 0.09 vs 0.00), balancing work and studying (- 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students. Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.

Internal Medicine Student Chief Elective.

With increasing patient care responsibilities, administrative work and education demands, physicians may find it challenging to provide high-quality and engaging clinical education to third-year medical students on clerkships. Fourth-year students in the role of near-peer teachers can help fill this role, but they often also have competing responsibilities. A 4-week Internal Medicine Student Chief (Student Chief) elective was created, designed such that fourth-year students would apply for dedicated time to serve as student leaders, coaches and educators for the third-year students on the Internal Medicine clerkship. They were provided an asynchronous medical education curriculum and conducted their own Medicine subject exam reviews, case conferences and feedback sessions. Course evaluations by clerkship students did not detect a significant difference between the "quality" of the Internal Medicine clerkship and the "amount of formative feedback" from pre-post Student Chief elective introduction. Clerkship students' feedback regarding their interactions with and the ratings of the Student Chief, however, were excellent. Evaluations by the Student Chief suggested that the course provided rich opportunities for students interested in medical education to learn and practice skills in teaching, mentoring and coaching of Internal Medicine clerkship students. Given overwhelmingly positive feedback, the Student Chief elective has continued. Student Chief responsibilities evolved based on feedback, and the Student Chiefs themselves develop their own learning goals for their experience. Future studies could include a more longitudinal evaluation of the program, expanding the scope of the Student Chief experience to other specialties and publication of an implementation toolkit.

Supporting medical students through time and space – creation of a longitudinal academic support system

Introduction: Academic support for medical students is rapidly evolving due to expanding medical student needs and a shifting medical education environment. This article describes a holistic longitudinal academic support program created to meet these challenges in a large multi-campus medical school. Program Organization and Implementation: Academic support through the Office of Academic Excellence (OAE) is primarily provided by 11 physician academic coaches, three Foundation Phase Academic Coaches (FPACs) and eight Clinical Phase Academic Coaches (CPACs) to provide education and guidance via class meetings, intensive one-on-one coaching, specialized programs and asynchronous resources. This is aimed at supporting resilience and study skill development, preparation for United States Medical Licensing Examination (USMLE) Step 1 and 2, and clinical and NBME subject exam success. Robust team communication internally, across other student resources, and across multiple regional campuses provides tailored, seamless support for medical students and ensures comparable experiences across campuses. Results: Since the founding, the group has grown in size and scope of interactions with students. The OAE has 3 FPACs plus at least one CPAC at each campus, conducting approximately 1,250 annual student meetings. Since the OAE’s inception, fewer students fail Step 1, and a trend towards improved Step 1 scores was noted. The OAE advocated for and created programs providing question banks and practice tests to students throughout medical school, and uses the scores to provide evidence-based proactive academic support. Discussion: Program success is attributable to continuous communication and coordination processes, robust support from Medical School administration, and agile, evidencebased, individualized student support.

Pass/fail grading in preclinical courses and differential attainment between racially/ethnically minoritized groups and non-minoritized groups

Many medical schools are transitioning to pass/fail grading from tiered grading systems which have been associated with increased competition, grade inflation, decreased wellness, and grading disparities along racial/ethnic lines. This retrospective cohort study followed two cohorts of students from one medical school for four years. One cohort was the last class to enter the school under a 5-point grading system for preclinical courses and the other was the first cohort to enter school under a pass/fail grading system for preclinical courses. Data was collected on various performance measures for the 501 students who comprised these two cohorts. Given the enduring problem of differential attainment between underrepresented in medicine (URiM) students to non-URiM students, we explored whether a change in grading systems impacted all students similarly. Overall students did as well or better in classroom performance, clerkship subject exams, and licensing exams following the change and the effect was essentially equal for URiM and non-URiM students alike. The most important finding was a decrease in differential attainment between URiM and non-URiM students after the change to pass/fail grading for the great majority of the performance measures studied.

Reinforcement of core foundational science concepts during clinical rotations: a strategy to enhance medical student learning and diagnostic reasoning.

Cognitive science principles can facilitate integrating and retaining basic science concepts during the clinical years of undergraduate medical education. We hypothesized that reinforcing foundational science concepts during the core clerkship experiences fosters the development of clinical reasoning in medical students. A patient simulation session on diabetic ketoacidosis (DKA) in the pediatric clerkship was chosen to pilot the program. We introduced an intervention in which a team of clinical and foundational science faculty facilitates student discussions, helping them connect important physiological and pathophysiological concepts to the disorder's clinical presentation, diagnosis, and management. The student survey reported that 87% strongly agreed that it helped them reinforce their understanding of foundational science concepts related to clinical cases. The National Board Medical Examination (NBME) subject exam results of the pediatric clerkships from the corresponding years were subjected to a cognitive diagnostic assessment called the DINA (deterministic input, noisy "and" gate) model analysis. The student content mastery in acid-base disorders was improved following the intervention (student mastery of skills, 0.73 vs. 0.80, P = 0.035). Similarly, analysis of the Step 2 Clinical Knowledge (CK) skills from the NBME subject exam item analysis reports showed improvement in the skill "diagnosis" on the topic of diabetes (probability value: before and after the intervention, respectively, 0.73 and 0.85, P = 0.04) following implementation. Our study shows the impact of foundational science reinforcement during clinical clerkships in developing undergraduate medical students' clinical reasoning and diagnostic skills.NEW & NOTEWORTHY The study describes a novel method for integrating foundational science into the clinical curriculum during undergraduate medical education. The learning outcomes are assessed using a cognitive diagnostic assessment method.

Snapshot of Examination Usage in Emergency Medicine Clerkships.

Objective Emergency Medicine (EM) clerkships often use a written exam to assess the knowledge gained over the course of an EM rotation in medical school. Clerkship Directors (CDs) may choose the National Board of Medical Examiners (NBME) EM Advanced Clinical Science Subject Exam (ACE), the Society for Academic Emergency Medicine (SAEM) M4 exam, which has two versions, the SAEM M3 exam, or departmental exams. There are currently no published guidelines or consensus regarding their utility. This survey-based study was designed to collect data regarding current practices of EM clerkship exam usage to analyze trends and variability in what exams are used and how. Methods The authors designed a cross-sectional observational survey to collect data from EM CDs on exam utilization in clerkships. The survey population consisted of clerkship directors, assistant clerkship directors, or faculty familiar assessments in their EM clerkship. Initial dissemination was by electronic distribution to subscribers of the Clerkship Directors in Emergency Medicine (CDEM) list-serve on the SAEM website. Subsequently, contact information of CD's from institutions that had not responded was obtained by manual search of the Emergency Medicine Residents' Association (EMRA) Match website and individual correspondence was sent at regular intervals. Data obtained include clerkship characteristics, exam used, weight of the exam relative to the overall grade, and alternatives if the preferred exam was previously taken. Results Eighty-seven programs (42% response rate) completed the survey between August 2019 and February 2021. Of the 87 responses, 71 (82%) were completed by a CD. Forty-six (53%) institutions required an EM rotation. Students were tested in 34 (74%) required EM clerkships and 48 (69%) out of 70 EM electives. In required rotations that used an exam, 20 (59%) used the NBME EM ACE, while 28 of 46 (61%) of EM electives that reported an exam used the SAEM M4 Exam. Five (15%) of the required clerkships used a departmental exam. Of clerkships requiring an exam, 46 (57%) weighed the score at 11-30% of the final grade. Data for extramural rotations mirrored that of EM electives. One-third of respondents indicated they do not inquire about previously taken exams. Conclusion This survey demonstrates significant variability in the type of exam, the weighting of the score, and alternatives if the preferred exam was previously taken. The lack of a consistent approach in how these exams are used in determining students' final EM grades diminishes the reliability of the EM clerkship grade as a factor used by residency directors in choosing future residents. Further research on optimal usage of these exams is needed.

Analysis of surgical oncology-educator perspectives for the development of a contemporary curriculum for the outpatient learning environment

PurposeThe purpose of this study was to perform a targeted needs assessment of surgical oncology stakeholders engaged in surgical education of students and trainees. The aim was to determine the appropriate elements of a formal curriculum to be administered to students and residents rotating in the outpatient surgical oncology setting.MethodsA 10-min survey was sent to surgical oncologists around the country that are a part of the Society of Surgical Oncology (SSO). Data obtained from this survey were analyzed to distinctly identify limitations to education in Surgical Oncology and will allow us to determine which educational goals to prioritize in a curriculum.Results189 responses to the needs assessment were received (7% response rate). Most surgeons were in academic practice (77%) and felt that trainees were not fully prepared for an outpatient clinic (57%) and did endorse the need for a curriculum (74%). Barriers identified to teaching and learning included time, abbreviated contact with learners and the volume of patients. Higher yield topics to be included in a future curriculum were identified. More than half of respondents felt that a curriculum could improve feedback, NBME Surgery Subject Exam scores, resident ABSITE scores and patient comfort.ConclusionsThis study represents a novel effort in assessing the unique needs of surgical oncologists within the outpatient learning environment. Building upon the insights gleaned from our survey, the next phase will entail conducting focus groups with respondents to delve deeper into the intricacies of designing an outpatient surgical oncology clinical curriculum tailored for medical students and junior residents. By fostering collaborative discussions among stakeholders, we aim to refine curriculum components in an iterative process and address identified gaps in educational resources and ultimately improve the quality of patient care in the outpatient setting.

Wellness Activities, Stress, and Academic Performance in Medical Students.

Medical student wellness has a range of effects from academic performance to tragic mortality. Many factors correlate with academic performance, including study environments, faculty support, research participation, and student attitude. Its relationship with student stress and wellness demonstrates mixed results. This study hopes to help clarify these resultsand will also assess the interplay of these factors in relation to the pre-clerkship and clerkship phases of medical school. This retrospective descriptive study was conducted using a de-identified database from 2017 to 2023, provided per an Institutional Review Board (IRB) protocol. The subjects were the students of the classes of 2021-2027 at the Kirk Kerkorian School of Medicine at UNLV. The database included performance data including semester, clinical subject, and USMLE Step 1 and Step 2 exam scores. Other data included variables relating to self-perceived stress and time spent in wellness activities before medical school and at the end of the pre-clerkship and clerkship phases of medical school. The effects of these variables were calculated with bivariate correlations and independent samples T-tests using cut-off points calculated from the class means of those variables. A total of 361 medical students were included in the study. Students with high wellness time had lower stress levels in both the pre-clerkship and clerkship phases of medical school (5.83 vs. 7.3 p < 0.001* and 5.74 vs. 8.49 p < 0.001*, respectively). Students with low stress levels in the pre-clerkship phase scored 5.81 points higher on the Step 1 exam (p = 0.013*). Clerkship phase stress levels were significantly negatively correlated with all clinical subject exams except for pediatrics. Stress levels in the pre-clerkship and clerkship phases had similar relationships with the second and third semester and Step 2 exams, respectively, although not statistically significant. Wellness activity time did not have a significant relationship with academic performance. Stress levels had significant negative relationships with many medical school exams. Although wellness activity time did not have a direct relationship with academic performance, its relationship with stress levels can allude to an indirect effect on academic performance. This, along with fending off burnout and stress, are reasons why medical student wellness should be a priority for medical schools, faculty, and their students.

Predicting and modifying success on the NBME surgery subject exam

Predicting and modifying success on the NBME surgery subject exam

Evaluating ChatGPT-4 in medical education: an assessment of subject exam performance reveals limitations in clinical curriculum support for students

This study evaluates the proficiency of ChatGPT-4 across various medical specialties and assesses its potential as a study tool for medical students preparing for the United States Medical Licensing Examination (USMLE) Step 2 and related clinical subject exams. ChatGPT-4 answered board-level questions with 89% accuracy, but showcased significant discrepancies in performance across specialties. Although it excelled in psychiatry, neurology, and obstetrics and gynecology, it underperformed in pediatrics, emergency medicine, and family medicine. These variations may be potentially attributed to the depth and recency of training data as well as the scope of the specialties assessed. Specialties with significant interdisciplinary overlap had lower performance, suggesting complex clinical scenarios pose a challenge to the AI. In terms of the future, the overall efficacy of ChatGPT-4 indicates a promising supplemental role in medical education, but performance inconsistencies across specialties in the current version lead us to recommend that medical students use AI with caution.

Comparing the Performance of Popular Large Language Models on the National Board of Medical Examiners Sample Questions.

Large language models (LLMs) have transformed various domains in medicine, aiding in complex tasks and clinical decision-making, with OpenAI's GPT-4, GPT-3.5, Google's Bard, and Anthropic's Claude among the most widely used. While GPT-4 has demonstrated superior performance in some studies, comprehensive comparisons among these models remain limited. Recognizing the significance of the National Board of Medical Examiners (NBME) exams in assessing the clinical knowledge of medical students, this study aims to compare the accuracy of popular LLMs on NBME clinical subject exam sample questions. The questions used in this study were multiple-choice questions obtained from the official NBME website and are publicly available. Questions from the NBME subject exams in medicine, pediatrics, obstetrics and gynecology, clinical neurology, ambulatory care, family medicine, psychiatry, and surgery were used to query each LLM. The responses from GPT-4, GPT-3.5, Claude, and Bard were collected in October 2023. The response by each LLM was compared to the answer provided by the NBME and checked for accuracy. Statistical analysis was performed using one-way analysis of variance (ANOVA). A total of 163 questions were queried by each LLM. GPT-4 scored 163/163(100%), GPT-3.5 scored 134/163 (82.2%), Bard scored 123/163 (75.5%), and Claude scored 138/163 (84.7%). The total performance of GPT-4 was statistically superior to that of GPT-3.5, Claude, and Bard by 17.8%, 15.3%, and 24.5%, respectively. The total performance of GPT-3.5, Claude, and Bard was not significantly different. GPT-4 significantly outperformed Bard in specific subjects, including medicine, pediatrics, family medicine, and ambulatory care, and GPT-3.5 in ambulatory care and family medicine. Across all LLMs, the surgery exam had the highest average score (18.25/20), while the family medicine exam had the lowest average score (3.75/5). Conclusion: GPT-4's superior performance on NBME clinical subject exam sample questions underscores its potential in medical education and practice. While LLMs exhibit promise, discernment in their application is crucial, considering occasional inaccuracies. As technological advancements continue, regular reassessments and refinements are imperative to maintain their reliability and relevance in medicine.

Promoting Longitudinal and Developmental Computer-Based Assessments of Clinical Reasoning: Validity Evidence for a Clinical Reasoning Mapping Exercise.

Clinical reasoning is vitally important for practitioners across the health professions. However, the assessment of clinical reasoning remains a significant challenge. Combined with other assessment methods, non-workplace-based assessment can increase opportunities to address multiple components of clinical reasoning, evaluate growth, and foster learning, but tools with validity evidence to assess clinical reasoning outside the workplace are scare. This study examined validity evidence for a novel clinical reasoning mapping exercise (CResME). Data include CResME performance scores from 120 third-year medical students at the University of Central Florida for 3 topics in May 2022. Each CResME was scored by 2 physician raters based on a scoring rubric that included a combined diagnosis and sequence score. Descriptive statistics were used to examine trends in scores. The authors gathered validity evidence for response process, internal structure, and relations to other variables. The overall mean (SD) score across cases was 66 (29). Internal consistency reliability of cases (Cronbach α) ranged from 0.75 to 0.91. The Phi and G coefficients were 0.45 and 0.56, respectively. Students accounted for 10% of the total variance, indicating the ability to differentiate high and low clinical reasoning skills; the interaction between learner and case accounted for 8.1% of the variance, demonstrating case specificity. There was a moderate correlation between the overall CResME scores and the mean overall score of patient encounter notes from an objective structured clinical examination performed at the end of the third year (0.46; P = .001). Significant associations were also found between the CResME scores and subject exam scores. The CResME can be used to facilitate the assessment of clinical reasoning, supporting the developmental progress of learners throughout the curriculum. Future research is needed to gather validity evidence for CResMEs with different learners across different settings and formats.

Pediatric Intersession: An Upfront Flipped-Classroom Curriculum to Promote Pediatric Clerkship Readiness.

Best practices for content selection, mode of delivery, and timing of pediatric clerkship readiness curricula for medical students have, by and large, not been established. Capitalizing on changes in structure of the clinical clerkships during the COVID-19 pandemic, we created an upfront clerkship readiness curriculum, termed Pediatric Intersession (PI), to replace the existing weekly lecture-based clerkship didactics. Our goal was to develop an interactive curriculum with innovative instructional design methodology intended to promote broad foundational pediatric knowledge and clerkship preparedness using case-based learning. We first conducted a needs assessment and crafted curriculum content using guiding principles from the 2019 Council on Medical Student Education in Pediatrics (COMSEP) curriculum. We then organized material into four daily modules prior to the start of the clerkship and employed flipped classroom (FC) methodology. Sixty-six percent of students completed course evaluations, and >90% of the 100 respondents reported that the PI enhanced their clinical learning. Pre-/post-testing demonstrated some knowledge gain following the small-group sessions and there was no change on the National Board of Medical Examiners (NBME) Subject Exam mean scores compared to prior cohorts of students. The global pandemic provided an opportunity to re-envision our pediatric clerkship didactics content, while also incorporating instructional design methodology preferred by students. Our curriculum promotes a small group-based, interactive approach to clerkship readiness that fosters learning in the clinical environment that can be adapted for various settings. Our evaluation suggests that the transition to a FC readiness curriculum can be done successfully while effectively preparing students for their pediatric clerkship.

Personality traits and health-related behaviors in medical students facing a stressful event.

It is believed that personality traits have an impact on the propensity to change and maintain favorable lifestyle habits. This issue has been raised by multiple studies, however, none of them appeared to focus on population under severe psychological stress. The aim of the present study was to investigate the link between personality traits and health-related behaviors and measures such as dietary intake of specific food products, physical activity, body-mass index and the use of cigarettes in medical students facing a stressful event. The study included a cohort of third-year medical students from the Medical University of Lodz, Poland, facing a stressful subject exam during the first COVID-19-related lockdown. At baseline, personality traits were evaluated with the use of the Polish version of the Big Five Inventory-Short questionnaire. Then, consumption of selected food products was monitored with the use of seven-day electronic dietary record. Also, some other health-related data was collected (body-mass index, physical activity and the use of cigarettes). General Linear Modeling techniques, logistic regression and exploratory factor analysis were applied to analyze the data. Four hundred and forty-four students completed the study. A two-factor pattern of food consumption was discovered by the exploratory factor analysis in the study group (34% of the variance explained). Higher conscientiousness, but not the other personality traits, was found to be significantly associated with generally healthier lifestyle manifested by higher consumption of vegetables, wholegrain products, fruits and nuts (adjusted beta 0.16, 95%CI 0.06 to 0.26, pη2 = 2.3%, p = 0.0015) and lower cigarette smoking (adjusted odds ratio 0.84, 95%CI 0.75 to 0.94, p = 0.0020), but insignificantly with physical activity and body-mass index. Severely stressed medical students expressing high conscientiousness tend to present healthier behaviors. Therefore, interventions aimed at improving lifestyle habits in students with low conscientiousness might be useful.

Impact of Obstetrics and Gynecology Clerkship Order on NBME Exam Scores After a Curriculum Change

Our Institution instituted curriculum reform in 2013. We sought to examine the impact of rotation order on the end of clerkship National Board of Medical Examiners (NBME) Obstetrics and Gynecology (Ob/Gyn) Subject Exam scores after curriculum restructuring. This is a retrospective analysis of Ob/Gyn NBME scores over 2 years after curriculum reform. At our university, a 15-week block is divided into 5-week intervals of General Surgery, Ob/Gyn, and surgical subspecialties, in any order. During the 16 weeks, students take the NBME Subject Examinations for Ob/Gyn and Surgery. We defined rotation groups by proximity to the shelf exam. Group 1 completed Ob/Gyn first, furthest away from the exam, Group 2 completed Ob/Gyn second, and Group 3 completed Ob/Gyn last, closest to the test. We compared average shelf exam scores between Groups. Uniformed Services University of Health Sciences during the clerkship year. Medical students at the Uniformed Services University. We obtained data from 331 students (118 students in Group 1, 106 in Group 2, and 107 in Group 3). Scores ranged from 55 to 99 (mean 72.5, SD 7.3). Mean (SD) NBME score was 71.9 (6.9) in Group 1, 73.2 (7.2) in Group 2, and 72.6 (7.7) in Group 3 (p = 0.415). Rotation order does not affect NBME Ob/Gyn Subject exam scores in a fifteen-week integrated clerkship block.

Natural Language Processing (NLP)-Driven Subjective Answer Ranking

Exams for universities and boards are administered offline each year. Many students show up for subjective exams. It took a lot of work to manually evaluate such a big number of papers. The evaluation's quality can occasionally fluctuate depending on the evaluator's attitude. The evaluation process takes a lot of time and effort. Objective or multiple choice questions are commonly found in competitive and entrance tests. These tests are reviewed using a machine because that is how they were administered, making evaluation simple. The manual evaluation of subjective papers is a difficult and taxing undertaking. A major obstacle when utilizing artificial intelligence (AI) to analyze subjective articles is a lack of understanding and acceptance of the findings. There have been numerous attempts to use computer science to evaluate student responses. To accomplish this objective, the majority of the effort, however, needs standard counts or precise terms. There are also not enough carefully selected data sets. In order to evaluate descriptive responses automatically, this paper proposes a novel approach that makes use of various machine learning, natural language processing, and tools like WorldNet, Word2vec, word mover's distance (WMD), cosine similarity, Multinomial Naive Bayes (MNB), and term frequency-inverse document frequency (TF-IDF). Responses are assessed using solution statements and keywords, and a machine learning model is built to forecast the grades of responses. Overall, the results indicate that WMD outperforms cosine similarity. The machine learning model could also be employed independently with appropriate training. Without the MNB model, experimentation produces an accuracy of 88%. Using MNB, the error rate is further decreased by 1.3%. Keywords - Subjective answer evaluation, big data, machine

Effect of shift-based scheduling on student learning, satisfaction and capacity in obstetrics and gynecology rotations.

Determine how a shift- based schedule to accommodate more students affects learning, performance, and satisfaction with the Obstetrics and Gynecology (OBG) rotation. The study was conducted among third year OBG medical students with a triangular convergent cross-sectional approach. A new shift-based schedule was implemented. After each rotation, an online survey was conducted using a convenience sampling. Student scores on the National Board of Medical Examiner (NBME) OBG subject exam were analyzed using paired t test. Survey data was analyzed using two sample t test. The relationship between survey responses and exam score findings were described. Data from shift-schedule students was compared to traditional schedule students from the prior academic year. A statistically significant improvement was seen for average NBME score for shift-schedule students during the beginning portion (groups 1-3) of the academic year (M=80, SD=6.9) compared to traditional (M=75.7, SD=7.3) [t (145) =3.69, p =.001]. A similar pattern was not seen in subsequent groups (groups 4-6). Shift-schedule students also showed a statistically significant improvement in their perception of learning (t (183) =-2.54, p =.012). Parallel results were seen for belonging, manageable workload, time to study, and engaging meaningfully. Using this model, we increased rotation capacity from 24 to 30 students per group (20%). Shift based scheduling allows 20% increase in capacity. Exam scores and student learning outcomes were similar or better than traditional schedule controls.

Medical Student Duty Hours and Shelf Performance: Is There a Correlation?

To date, there is limited information about medical student duty hours, shelf scores, and overall clerkship performance in obstetrics and gynecology (OB/GYN). As a result, we were curious to know whether spending more time in the clinical environment translated to an improved learning experience or, in contrast, translated to decreased study time and worse overall clerkship performance. A retrospective cohort analysis was performed at a single academic medical center of all medical students on the OB/GYN clerkship from August 2018 to June 2019. Recorded student duty hours were tabulated per day and per week, by student. National Board of Medical Examiners (NBME) Subject Exam (Shelf) equated percentile scores for the quarter of year were used. Our statistical analysis showed that working long hours did not translate to higher or lower shelf score, or higher overall clerkship grade. However, working longer hours in the last 2 weeks of the clerkship was associated with high shelf score. Longer medical student duty hours did not correlate to higher shelf scores or overall clerkship grades. Future multicenter studies are necessary to evaluate the importance of medical student duty hours and continue optimizing the educational experience of the OB/GYN clerkship. · Clinical hours were not associated with shelf examination scores.. · Clinical hours were not associated with overall clerkship grade.. · Longer clinical hours at the end of clerkship are correlated with higher examination scores..

Multivariate Modeling of Student Performance on NBME Subject Exams.

Aim This study sought to determine whether it was possible to develop statistical models which could be used to accurately correlate student performance on clinical subject exams based on their National Board of Medical Examiner (NBME) self-assessment performance and other variables, described below, as such tools are not currently available. Methods Students at a large public medical school were provided fee vouchers for NBME self-assessments before clinical subject exams. Multivariate regression models were then developed based on how self-assessment performance correlated to student success on the subsequent subject exam (Medicine, Surgery, Family Medicine, Obstetrics-Gynecology, Pediatrics, and Psychiatry) while controlling for the proximity of the self-assessment to the exam, USMLE Step 1 score, and the academic quarter. Results The variables analyzed satisfied the requirements oflinear regression. The correlation strength of individual variables and overall models varied by discipline and outcome (equated percent correct or percentile, Model R2 Range: 0.1799-0.4915). All models showed statistical significance on the Omnibus F-test (p<0.001). Conclusion The correlation coefficients demonstrate that these models have weak to moderate predictive value, dependent on the clinical subject, in predicting student performance; however, this varies widely based on the subject exam in question. The next step is to utilize these models to identify struggling students to determine if their use reduces failure rates and to further improve model accuracy by controlling for additional variables.