Kyra A. Len, MD, MD, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, Barry M. Mizuo, MD, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, Chieko Kimata, MD, Hawaii Pacific Health, Honolulu, HI
Longitudinal clinical clerkships are an innovative alternative to traditional block rotations during the third year of medical school. Literature about longitudinal clinical clerkships have shown promising outcomes including improved academic results, better continuity with patients and faculty preceptors, and enhanced patient centeredness. The University of Hawaii John A. Burns School of Medicine (JABSOM) longitudinal clerkship was first offered in 1992. The structure of JABSOM’s longitudinal clerkship involves 5.5 months spent training between various medical specialties in a rural outpatient setting. A primary goal for the program has been to attract more students towards the practice of primary care. The JABSOM longitudinal clerkship has also emphasized patient centeredness and learner centeredness in the curriculum, which has been well received by students. There is a need to determine whether the longitudinal clerkship provides comparable learning outcomes to the traditional block rotation during the pediatric clerkship.
Methods: Pediatric clerkship grades, National Board of Medical Examiners (NBME) shelf examination scores, and clinical evaluations were compared between longitudinal and traditional block students from 2008-2012. The percent of students deciding to pursue pediatrics in the two groups, as well as other primary care disciplines, was also compared. Statistical analysis was performed with the t. test, Wilcoxon rank sums test, and fisher exact test.
Results: The traditional block students received higher average shelf examination scores than longitudinal students; with a mean percentage of 79.8% for traditional block students vs 75.9% for longitudinal students (p=0.0041). There was no difference between the overall grades received by either group. A similar proportion of students in each group chose to pursue pediatrics (10% for traditional block, 9% for longitudinal clerkship). Student selection of other primary care fields was also similar between study groups.
Conclusion: The longitudinal clerkship track did not seem to provide any advantage in persuading students to pursue pediatrics or other primary care specialties. There was no statistical difference in the overall grades received by pediatric longitudinal clerkship students and traditional block students. However, shelf examination scores were slightly lower in the longitudinal student group