Available online 3 June 2023

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Numerous institutions have reduced preclinical didactic time to facilitate earlier clinical exposure during the second year of medical education. However, the effects that shortened preclinical education may have on performance in the surgery clerkship are unclear. This study aims to compare the clinical and examination performance of second- (MS2) and third-year (MS3) students synchronously completing an identical surgery clerkship.

Design

All students completing the surgery clerkship (identical didactics, examinations, clinical rotations, etc.) were included. MS3s received 24 months of preclinical education, whereas MS2s received 14 months. Performance outcomes included weekly quizzes based on lectures, NBME Surgery Shelf Exam, numeric clinical evaluations, objective structured clinical examination (OSCE) scores, and overall clerkship grades.

Setting

University of Miami Miller School of Medicine.

Participants

All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over 1 year (n = 395).

Results

There were 199 MS3 (50%) and 196 MS2 (50%) students. MS3s demonstrated higher median shelf exams (77% vs 72% MS2s), weekly quiz score averages (87% vs 80% MS2s), clinical evaluations (96% vs 95% MS2s), and overall clerkship grades (89% vs 87% MS2s), all p < 0.020. There was no difference in median OSCE performance (both 92%; p = 0.499). A greater proportion of MS3 students performed in the highest 50% of weekly quiz scores (57% vs 43% MS2), NBME shelf exams (59% vs 39% MS2), and overall clerkship grades (45% vs 37% MS2), all p < 0.010. No significant difference in the proportion of students placing in the top 50% of clinical parameters including the OSCE (48% MS3 vs 46% MS2; p = 0.106) and clinical evaluations (45% MS3 vs 38%; p = 0.185) was observed.

Conclusions

Although the duration of preclerkship education may correspond to examination scores, MS2s and MS3s perform similarly on clinical metrics. Future strategies to enhance available preclinical didactic time and preparation for examinations are needed.

Section snippetsINTRODUCTION

Undergraduate medical education has undergone sweeping pedagogical changes over the past few decades with over one-third of US allopathic medical schools having redesigned their curricula as of 2015.1, 2, 3 For nearly a century, medical institutions embraced the Flexnerian model of 2 years of preclinical education followed by 2 years of clinical training.4 However, the past 2 decades have witnessed an increasing reform to shorten the preclinical phase of medical education. Numerous institutions

Cohort Selection and Data Source

Deidentified data from all medical students completing the surgery clerkship at a single academic institution from July 2020 to August 2021 were compiled. This retrospective comparative study was deemed exempt from review by our Institutional Review Board.

Curriculum Design

Prior to the 2020 to 2021 academic year, all medical students in our institution received 24 months of preclinical didactic time encompassing the first 2 years of medical education prior to taking the USMLE Step 1 exam and entering MS3 to

RESULTS

There were 395 students identified during the study period of whom 50% (n = 199) were MS3s and 50% (n = 196) were MS2 students. Students were classified into their quartile of performance from the bottom 25% (Q4) to the top 25% (Q1) on each grading parameter (Table 1). Median performance was higher among the MS3 cohort with regards to clinical evaluation, NBME shelf exam, weekly quiz average, and overall clerkship scores compared to MS2s (Table 2). However, there was no difference in median

DISCUSSION

Overall, this study is one of the largest to directly compare medical student performance on the surgery clerkship based on the duration of their preclinical medical education. Third-year medical students demonstrated higher median scores on clinical evaluations, weekly quizzes, NBME shelf exam, and the overall clerkship grade. Furthermore, MS3s more frequently scored in the top 50% of performers on objective metrics including the shelf exam, weekly quizzes, and overall surgery grade. There was

CONCLUSIONS

The present study is one of the only series undertaken to compare medical student performance on the surgery clerkship stratified by the length of their preclerkship education. These results suggest that the duration of preclinical education is related to student performance on objective examination parameters but does not negatively impact clinical performance on the surgery clerkship. Future educational interventions should be undertaken to improve performance on standardized objective

AUTHOR STATEMENT

Study conception and design: CT Huerta. Acquisition of data: CT Huerta, BL Cohen, AE Hernandez, RA Saberi, and LR Sands. Analysis/interpretation of data: CT Huerta. Drafting of manuscript: CT Huerta. Critical revision of manuscript: All authors.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are not publicly available as they contain confidential academic information.

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© 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.