Council on Medical Student Education in Pediatrics

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COMSEP 2008 Atlanta Meeting

Poster Presentation:


Impact of Inpatient Teaching Site on Student Performance and Career Choice

Authors:
Lisa E. Leggio, William P. Kanto, Jr.,
Medical College of Georgia

Background: With increasing numbers of medical students and decreasing census on inpatient pediatrics wards, alternative venues for inpatient experience are needed.   Community-based sites and subspecialty teams may provide effective clinical experience during the pediatric clerkship.
Objective: To determine differences in exam performance, clinical performance, and career choice in students completing their pediatric clerkship at the home academic-hospital-based site on a general inpatient pediatrics team compared to those on a subspecialty inpatient team or at community-based sites with variable inpatient exposure.
Methods: The following data were compared across sites for all students completing their pediatric clerkship at the Medical College of Georgia (MCG) from July 2001 to June 2007: scores on a departmental written exam, the National Board of Medical Examiners (NBME) pediatric subject exam, subjective clinical grade, final calculated grade, and percent of students selecting pediatrics as their career choice. Comparisons were made between MCG general team (MCG-Gen), MCG subspecialty teams (MCG-SS), and community sites (CS).
Results: A total of 1,046 students completed their pediatric clerkship between July 2001 and June 2007. Three-hundred fifty eight (34.2%) were assigned to MCG-Gen, 289 (27.6%) to MCG-SS, and 399 (38.1%) to one of 21 CS. The difference between mean clinical grades at MCG-SS (89%) and CS (90.3%) was statistically significant (p<0.001), but there was no statistically significant difference in clinical grades between MCG-Gen (89.7%) and MCG-SS or CS. Differences in mean departmental exam scores, NBME scores, and final grades between groups were not statistically significant.   Of the 139 students matching in a pediatrics residency from 2003-2007, 51 (36.7%) did their pediatric clerkship at MCG-Gen, 45 (32.4%) at MCG-SS, and 43 (30.9%) at CS. These differences were not statistically significant.
Conclusion: Community sites and subspecialty teams are reasonable alternatives for clinical teaching. Students perform as well on objective measures as on an academic general inpatient team. Faculty development is needed to standardize subjective clinical grading. Site of inpatient teaching does not impact career choice.