“达到标准”：医学生临床实习成绩的非认知预测因素
"Making the grade:" noncognitive predictors of medical students' clinical clerkship grades.
作者信息
Lee Katherine B, Vaishnavi Sanjeev N, Lau Steven K M, Andriole Dorothy A, Jeffe Donna B
机构信息
Washington University School of Medicine, St. Louis, MO 63108, USA.
出版信息
J Natl Med Assoc. 2007 Oct;99(10):1138-50.
OBJECTIVES
Because clinical clerkship grades are associated with resident selection and performance and are largely based on residents'/attendings' subjective ratings, it is important to identify variables associated with clinical clerkship grades.
METHODS
U.S. medical students who completed > or =1 of the following required clinical clerkships--internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology and psychiatry--were invited to participate in an anonymous online survey, which inquired about demographics, degree program, perceived quality of clerkship experiences, assertiveness, reticence and clerkship grades.
RESULTS
A total of 2395 medical students (55% women; 57% whites) from 105 schools responded. Multivariable logistic regression models identified factors independently associated with receiving lower clerkship grades (high pass/pass or B/C) compared with the highest grade (honors or A). Students reporting higher quality of clerkship experiences were less likely to report lower grades in all clerkships. Older students more likely reported lower grades in internal medicine (P = 0.02) and neurology (P < 0.001). Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001); Asians more likely reported lower grades in obstetrics/gynecology (P = 0.007), pediatrics (P = 0.01) and neurology (P = 0.01). Men more likely reported lower grades in obstetrics/gynecology (P < 0.001) and psychiatry (P = 0.004). Students reporting greater reticence more likely reported lower grades in internal medicine (P = 0.02), pediatrics (P = 0.02) and psychiatry (P < 0.05). Students reporting greater assertiveness less likely reported lower grades in all clerkships (P < 0.03) except IM.
CONCLUSIONS
The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation.
目的
由于临床实习成绩与住院医师选拔和表现相关，且很大程度上基于住院医师/带教老师的主观评分，因此识别与临床实习成绩相关的变量很重要。
方法
邀请完成以下至少一项必修临床实习的美国医学生——内科、外科、妇产科、儿科、神经科和精神科——参与一项匿名在线调查，该调查询问了人口统计学信息、学位项目、对实习经历质量的感知、自信、沉默寡言和实习成绩。
结果
来自105所学校的2395名医学生（55%为女性；57%为白人）做出了回应。多变量逻辑回归模型确定了与获得低于最高成绩（优等或A）的较低实习成绩（高通过/通过或B/C）独立相关的因素。报告实习经历质量较高的学生在所有实习中报告较低成绩的可能性较小。年龄较大的学生在内科（P = 0.02）和神经科（P < 0.001）中更有可能报告较低成绩。代表性不足的少数族裔在所有实习中更有可能报告较低成绩（P < 0.001）；亚洲人在妇产科（P = 0.007）、儿科（P = 0.01）和神经科（P = 0.01）中更有可能报告较低成绩。男性在妇产科（P < 0.001）和精神科（P = 0.004）中更有可能报告较低成绩。报告更沉默寡言的学生在内科（P = 0.02）、儿科（P = 0.02）和精神科（P < 0.05）中更有可能报告较低成绩。报告更自信的学生在除内科外的所有实习中报告较低成绩的可能性较小（P < 0.03）。
结论
较低的实习成绩与非白人种族、男性、年龄较大、较低的实习经历质量以及不太自信和更沉默寡言之间的独立关联令人担忧，值得进一步研究。
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