Griffith Charles H, Wilson John F, Haist Steve A, Albritton T Andrew, Bognar Bryan A, Cohen Stuart J, Hoesley Craig J, Fagan Mark J, Ferenchick Gary S, Pryor Othelia W, Friedman Erica, Harrell Heather E, Hemmer Paul A, Houghton Bruce L, Kovach Regina, Lambert David R, Loftus Tayloe H, Painter Thomas D, Udden Mark M, Watkins Raquel S, Wong Raymond Y
University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Acad Med. 2009 Jul;84(7):895-901. doi: 10.1097/ACM.0b013e3181a82013.
To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance.
The authors collected data from 17 U.S. medical schools (1,817 students) regarding characteristics of their IM clerkships, including structural characteristics, pedagogical approaches, patient contact, and clinical teacher characteristics. Outcomes of interest were postclerkship National Board of Medical Examiners (NBME) subject examination score, United States Medical Licensing Examination (USMLE) 2 score, and change in score from USMLE 1 to 2. To examine how associations of various clerkship characteristics and examination performance may differ for students of different prior achievement, the authors categorized students into those who scored in the top (1/4) of the cohort on USMLE 1 and the bottom (1/4). The authors conducted analyses at both the school and the individual student levels.
In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement.
Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.
确定哪些内科实习特征与学生更好的考试成绩相关。
作者收集了来自17所美国医学院校（1817名学生）关于其内科实习特征的数据，包括结构特征、教学方法、患者接触情况以及临床教师特征。感兴趣的结果是实习后美国国家医学考试委员会（NBME）学科考试成绩、美国医师执照考试（USMLE）第2步考试成绩以及从USMLE第1步到第2步的成绩变化。为了研究不同先前成绩的学生，各种实习特征与考试成绩之间的关联可能如何不同，作者将学生分为在USMLE第1步考试中成绩位于队列前四分之一和后四分之一的学生。作者在学校和个体学生层面都进行了分析。
在学校层面的分析中（使用简化的四变量模型），与更高的NBME学科考试成绩相关的自变量是每周更多的小组学习时间以及使用社区带教老师。从USMLE第1步到第2步成绩提升更大与学生每天照顾更多患者有关。在学生层面，有几个变量与学生考试成绩提高相关。最一致的发现是每天照顾更多患者与更高的考试成绩相关。对于基线USMLE第1步成绩较低的学生，更多结构化学习活动与更高的考试成绩相关。
某些实习特征与学生更好的考试成绩相关，最显著的是每天照顾更多患者。
