Cutting Too Deep? Assessing the Impact of a
Shorter Surgery Clerkship on Students’
Clinical Skills and Knowledge
Navin D. Bhatia, Colleen C. Gillespie, Alexandra J. Berger,
Mark S. Hochberg, Jennifer B. Ogilvie
New York University School of Medicine
04/23/2013
Background
•In 2011, the New York University School of Medicine initiated
implementation of a new Curriculum for the 21st Century
•Changes to the core clinical year included shortening of the
Surgery Clerkship from 8 weeks to 6
•Previous school-specific studies have found a decline in student
performance following such a reduction in surgery clerkship
length1
•We sought to evaluate the impact of this new clerkship duration on
medical students’ performance in an Objective Structured Clinical
Examination (OSCE) and the National Board of Medical
Examiners (NBME) Clinical Science Surgery Examination
1 Lind et al, J Surg Res, 1999.
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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Methods
• 214 medical students from 2010-2011 were included in the
study
• 115 from the first four blocks of the 8-week clerkship
• 99 from the first four blocks of the 6-week clerkship
• Performance on an end-of-clerkship OSCE was calculated
across 8 sub-domains, using a behaviorally-anchored checklist
• Scores were calculated as the mean of relevant items
• Response options: Not Done, Partly Done, Done
• NBME exams were assessed by the NBME, using standard
scaled scores
• Results were compared using a 2-tailed, independent-sample,
unequal variance t-test
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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OSCE Grading Sheet
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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OSCE Grading Sheet
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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Results
•
Mean Overall OSCE scores did not statistically differ between
the 6 week (92.92, SD 6.01) and 8 week (93.21, SD 5.64)
clerkships (t =.37, p=.71)
•
Mean NBME exam results in the 6 and 8-week clerkships
(75.26 vs. 76.13) were also not found to be statistically
different (t=.81, p=.42)
•
Students in the 6-week clerkship performed better in four of
the 8 OSCE sub-domains:
•
•
•
•
Blood pressure measurement
Orthostatic blood pressure measurement
Rectal exam
Fecal occult blood test
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
6
Results
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
7
Results
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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Results
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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Conclusions
• Overall clinical performance in a summative OSCE and
the NBME exam did not differ between students in an 8
week vs. 6 week surgery clerkship
• Students in the 6-week clerkship performed better in
specific procedural components of the OSCE, including
BP measurement and rectal/fecal occult blood exams
• Further research will explore whether this enhanced
clinical performance in specific competencies was due to
differences in clinical training prior to the clerkship, and/or
differences in the composition of the student classes
Cutting Too Deep? Assessing the Impact of a Shorter Surgery Clerkship
on Students’ Clinical Skills and Knowledge
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Cutting Too Deep? Assessing the Impact of a Shorter Surgery