Gary L. Beck, PhD, Sharon R. Stoolman, MD, University of Nebraska College of Medicine, Omaha, NE
Background: Standardized, computer-based cases are being used as an educational modality in medical schools. Since 2006, all of our students used cases that have been used nationally by pediatric clerkships. These cases encourage clinical reasoning on pediatric topics, which should facilitate knowledge acquisition and retention.
Hypothesis: We investigated the relationship between case use or patient log numbers with NBME performance. We hypothesized that neither case use nor patient log numbers would predict examination results.
Participants:All students from a Midwest medical school completing the pediatrics clerkship from 2006 to 2011 were eligible; 471 were included in this study.
Methods: Participants were required to log patient encounters in which they played an active role in patient care. Case usage statistics were also used, excluding average minutes that were outliers. The NBME Subject Exam was used as an objective assessment for the clerkship. Correlation coefficients and linear regression were used to analyze the relationship between case use (total number of cases used and average minutes per case), patient log numbers, and NBME scores.
Results: The total number of cases completed and total time spent on cases were not associated with examination performance. Average time per cases was negatively associated with NBME performance (r=-.145, p<.01). The number of patients logged was positively associated with NBME performance (r=.090, p<.05). Predictor variables were entered into the linear regression model. Results of this analysis indicated average minutes (B=-.061, t=3.498, p=.001) contributed 3.3% negative variance to NBME scores.
Conclusions: It has been suggested that structured simulated cases will enhance NBME performance. Course evaluation comments indicated students found the cases very thorough albeit time intensive. Our findings indicate that increased time spent on cases was negatively correlated with examination performance. Students indicated they prefer using materials that allow them to cover more topics in a shorter period to complement patient care. Although the findings from these analyses are small, the results from this study raise questions about the gains from investing in simulated cases, not only students time but also departmental resources.