临床实习轮转顺序会影响美国医学考试委员会（NBME）临床科目考试以及美国医师执照考试（USMLE）第二步临床知识（CK）考试的成绩吗？

Does Clerkship Rotation Sequence Affect Performance on National Board of Medical Examiners (NBME) Clinical Subject Examinations and United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) Examination?

作者信息

Gao Hong, Askew Kim, Violato Claudio, Manthey David, Burns Cynthia, Vallevand Andrea

机构信息

Medical Education and Director of Evaluations, Wake Forest School of Medicine, Winston-Salem, NC USA.

Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA.

出版信息

Med Sci Educ. 2019 May 20;29(3):763-770. doi: 10.1007/s40670-019-00744-y. eCollection 2019 Sep.

DOI:10.1007/s40670-019-00744-y

PMID:34457540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8368587/

Abstract

PURPOSE

To investigate whether starting the clerkship year in family medicine (FM), internal medicine (IM), pediatrics, or surgery influences NBME shelf and USMLE Step 2 CK examination performance.

METHODS

USMLE Step 1, Step 2 CK, and shelf examination scores for FM, IM, pediatrics, and surgery were collected. Sequences were selected on the following assignment criteria: rotation 1 (either FM or IM), rotation 5 (pediatrics), rotation 8 (surgery), rotation 1 (either pediatrics or surgery), and rotation 8 (IM). Multivariate analysis of covariance, with Step 1 as the covariate, was used to investigate rotation sequence on examination performance.

RESULTS

Wilks's statistic found no statistically significant effect of rotation sequence (starting the clerkship year in FM or IM) on the pediatrics, surgery, and Step 2 CK examinations ( = .95, [3,51] = .93, ≤ .432). Wilk's statistic for the covariate (Step 1) was statistically significant ( = .488, [3,51] = 17.827, ≤ .001), indicating the two groups differ on Step 1 performance. Wilk's statistic found no statistically significant effect of rotation sequence (starting the clerkship year in pediatrics or surgery) on the IM and Step 2 CK results ( = .925, [2,75] = 3.036, ≤ .054). Wilk's statistic for the covariate (Step 1) was statistically significant ( = .309, [2,75] = 83.915, ≤ .001) indicating that the two groups differ on Step 1 performance.

CONCLUSION

Starting the clerkship year in FM, IM, pediatrics, or surgery does not influence subsequent performance on shelf examinations or on Step 2 CK.

摘要

目的

探讨在家庭医学（FM）、内科（IM）、儿科学或外科学开始见习年是否会影响美国国家医学考试委员会（NBME）阶段性评估考试成绩及美国医师执照考试（USMLE）第二步临床知识（CK）考试成绩。

方法

收集FM、IM、儿科学和外科学的USMLE第一步、第二步CK及阶段性评估考试成绩。根据以下分配标准选择顺序：轮转1（FM或IM）、轮转5（儿科学）、轮转8（外科学）、轮转1（儿科学或外科学）以及轮转8（IM）。以第一步考试成绩作为协变量，采用多变量协方差分析来研究轮转顺序对考试成绩的影响。

结果

威尔克斯统计量表明，轮转顺序（在FM或IM开始见习年）对儿科学、外科学及第二步CK考试成绩无统计学显著影响（Λ = 0.95，F[3,51] = 0.93，P ≤ 0.432）。协变量（第一步考试成绩）的威尔克斯统计量具有统计学显著性（Λ = 0.488，F[3,51] = 17.827，P ≤ 0.001），表明两组在第一步考试成绩上存在差异。威尔克斯统计量表明，轮转顺序（在儿科学或外科学开始见习年）对IM及第二步CK考试成绩无统计学显著影响（Λ = 0.925，F[2,75] = 3.036，P ≤ 0.054）。协变量（第一步考试成绩）的威尔克斯统计量具有统计学显著性（Λ = 0.309，F[2,75] = 83.915，P ≤ 0.001），表明两组在第一步考试成绩上存在差异。