gms | German Medical Science

Question: In this study we investigated the power of a multidisciplinary and extensive pre-clinical course on predicting clerkship poor performances, as assessed at the workplace by multiple clinicians. We were interested in testing the effect of different types of assessment.

Methods: The participants were 149 students who have concluded all of the (30) clerkships in the curriculum (118/360 ECTS). The setting is a medical school with a 6-year integrated curriculum. The clerkships in several specialties make up the 4th-6th years and take place in two hospitals and several health centers (urban and rural). In every clerkship, each student is assessed by a clinician with the “Jefferson Medical College” rubric (16-items, in a 9-point scale containing descriptors of performance) for assessment of Professionalism and Clinical Competence. The aggregate clinician marks contribute 25% to the final clerkship score. The course “Biopathology and Introduction to Therapeutics” represents 23% of all the 3 pre-clinical years credits (42/180 ECTS). The course is clinically oriented and is organized in 5 modules. Different types of assessment are used:

1.

“integrated“ written exam at the conclusion of the course, largely made up of open questions on clinical vignettes;

2.

“module” written exams at the conclusion of each module, largely MCQ with some clinical vignettes;

3.

a stations practical exam at the conclusion of each module;

4.

an attitude mark (an aggregate mark resulting from rubrics handed by faculty).

Student demographic variables (sex, age) and GPA at entrance were also used. A logit binary choice model was used in the quest for predictors. An exploratory analysis revealed that 10% students had 11 or more occurrences in the lowest quartile of mark/clerkship of professionalism or clinical competence. Thus the “problematic student” (dependent variable=1) was defined as the one with 11 or more marks bellow the first quartile.

Results: Lower probabilities of being a “problematic student” are associated with higher grades in the “integrated” exam (marginal effect (me): -3 percentage points (pp); odd ratio (or): 0.74), higher attitude marks (me: -2.9 pp; or: 0.75) and with being a female student (me: -15.8 pp; or: 0.27). The remaining independent variables, e.g. MCQ exams, did not exhibit statistical significance.

Conclusions: The integrated exam and the attitude marks of the pre-clinical course were predictors of clinician assessment of student professionalism and clinical competence. The predictive method is applicable in other schools as long as a crucial course (or aggregate marks of several key courses) in the early years are identified. The importance of scoring student attitudes in pre-clinical courses was established. Finally, the study provides evidence that MCQ exams are very weak in predicting professionalism and clinical competence. Generalization of our findings requires increasing the sample and testing the method in other medical schools [1], [2].