医学院临床实习表现的预测因素：标准化考试成绩与临床评估的多专业纵向分析
Predictors of medical school clerkship performance: a multispecialty longitudinal analysis of standardized examination scores and clinical assessments.
作者信息
Casey Petra M, Palmer Brian A, Thompson Geoffrey B, Laack Torrey A, Thomas Matthew R, Hartz Martha F, Jensen Jani R, Sandefur Benjamin J, Hammack Julie E, Swanson Jerry W, Sheeler Robert D, Grande Joseph P
机构信息
Division of Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
出版信息
BMC Med Educ. 2016 Apr 27;16:128. doi: 10.1186/s12909-016-0652-y.
BACKGROUND
Evidence suggests that poor performance on standardized tests before and early in medical school is associated with poor performance on standardized tests later in medical school and beyond. This study aimed to explore relationships between standardized examination scores (before and during medical school) with test and clinical performance across all core clinical clerkships.
METHODS
We evaluated characteristics of 435 students at Mayo Medical School (MMS) who matriculated 2000-2009 and for whom undergraduate grade point average, medical college aptitude test (MCAT), medical school standardized tests (United States Medical Licensing Examination [USMLE] 1 and 2; National Board of Medical Examiners [NBME] subject examination), and faculty assessments were available. We assessed the correlation between scores and assessments and determined USMLE 1 cutoffs predictive of poor performance (≤10th percentile) on the NBME examinations. We also compared the mean faculty assessment scores of MMS students vs visiting students, and for the NBME, we determined the percentage of MMS students who scored at or below the tenth percentile of first-time national examinees.
RESULTS
MCAT scores correlated robustly with USMLE 1 and 2, and USMLE 1 and 2 independently predicted NBME scores in all clerkships. USMLE 1 cutoffs corresponding to poor NBME performance ranged from 220 to 223. USMLE 1 scores were similar among MMS and visiting students. For most academic years and clerkships, NBME scores were similar for MMS students vs all first-time examinees.
CONCLUSIONS
MCAT, USMLE 1 and 2, and subsequent clinical performance parameters were correlated with NBME scores across all core clerkships. Even more interestingly, faculty assessments correlated with NBME scores, affirming patient care as examination preparation. USMLE 1 scores identified students at risk of poor performance on NBME subject examinations, facilitating and supporting implementation of remediation before the clinical years. MMS students were representative of medical students across the nation.
背景
有证据表明，医学院校入学前及入学初期标准化考试成绩不佳与医学院校后期及毕业后标准化考试成绩不佳有关。本研究旨在探讨医学院校期间（入学前和在校期间）标准化考试成绩与所有核心临床实习的考试成绩及临床能力之间的关系。
方法
我们评估了梅奥医学院（MMS）2000年至2009年入学的435名学生的特征，这些学生的本科平均绩点、医学院入学能力测试（MCAT）、医学院标准化考试（美国医师执照考试[USMLE]第1和第2步；美国国家医学考试委员会[NBME]学科考试）以及教师评估数据均可用。我们评估了成绩与评估之间的相关性，并确定了预测NBME考试成绩不佳（≤第10百分位数）的USMLE第1步考试分数临界值。我们还比较了MMS学生与访学生的教师评估平均成绩，对于NBME考试，我们确定了成绩处于首次全国考生第10百分位数及以下的MMS学生的百分比。
结果
MCAT成绩与USMLE第1和第2步考试成绩密切相关，且USMLE第1和第2步考试成绩在所有实习中均能独立预测NBME考试成绩。与NBME考试成绩不佳相对应的USMLE第1步考试分数临界值在220至223分之间。MMS学生与访学生的USMLE第1步考试成绩相似。在大多数学年和实习中，MMS学生的NBME考试成绩与所有首次考生的成绩相似。
结论
MCAT、USMLE第1和第2步考试成绩以及随后的临床能力参数与所有核心实习的NBME考试成绩相关。更有趣的是，教师评估与NBME考试成绩相关，这证实了临床护理对考试准备的作用。USMLE第1步考试成绩可识别出NBME学科考试成绩不佳风险的学生，便于并支持在临床学年之前实施补救措施。MMS学生代表了全国的医学生。
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