M.M. Fitz is vice chair for faculty development, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois.
W. Adams is assistant professor of medical education and public health sciences, Loyola University Chicago, Chicago, Illinois.
Acad Med. 2020 Sep;95(9):1404-1410. doi: 10.1097/ACM.0000000000003322.
To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates.
The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011-2014).
The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001).
In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.
鉴于内科实习开始日期提前的趋势越来越明显，确定哪些内科实习特点可能与 NBME 医学科目考试成绩相关。
作者使用线性混合效应模型（单变量和多变量）来确定考试成绩与实习特点（纵向状态、实习长度、学术开始月份、门诊临床经验、是否有学习日、参与联合实习、基础临床课程类型、医学考试时间）之间的关联。其他协变量包括使用的 NBME 临床科目考试数量、理论课小时数、使用通过医学考试的标准分数、医学考试成绩是否用于指定实习荣誉，以及美国医师执照考试第 1 步成绩。样本包括来自 62 所医学院的 24542 名考生，涵盖 3 个学年（2011-2014 年）。
多变量分析发现实习长度与医学考试成绩之间无显著关联（所有两两比较 P >.05）。然而，少数在 1 月开始学术学期的考生比在 7 月开始的考生得分略低（P <.001）。相反，在学术年后期，考生在医学考试中的得分更高（所有两两比较 P <.001）。使用通过医学考试标准分数的学校的考生比不使用的学校的考生得分更高（P <.05）。即使在控制模型中所有其他变量后，第 1 步成绩仍然与医学考试成绩呈正相关（P <.001）。
在本样本中，作者未发现许多实习变量与医学考试成绩之间存在关联。相反，第 1 步成绩是医学考试成绩的最强预测因素。这些发现表明，医学考试成绩反映了学生在整个医学教育过程中积累的整体医学知识，而不是任何特定的内科实习特点。
