Kyra A. Len,University of Hawaii John A. Burns School of Medicine,Honolulu,HI,Barry M. Mizuo,University of Hawaii John A. Burns School of Medicine,Honolulu,HI,Chieko Kimata,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 a comparable learning outcomes compared to traditional block rotations.
Methods: Medical College Admission Test (MCAT) scores, United States Medical Licensing Examination (USMLE) Step 1 scores, USMLE Step 2 scores, Clerkship grades, National Board of Medical Examiners (NBME) shelf examination scores or departmental exam scores were compared between longitudinal and traditional block students from 2008-2012. The field of match was also compared. Statistical analysis was performed with the t. test, Wilcoxon rank sums test, and fisher exact test. A two-sided p-value <0.05 was considered statistically significant.
Results: A total of 240 students between 2008-2012 were included in the study. At baseline, there was no difference between the two groups in MCAT, USMLE Step 1 and Step 2 scores. Traditional block students received higher average pediatric shelf examination scores (79.8% vs 75.9%, p=0.004) and surgery clerkship grades (40% honors for traditional students vs 18.7% for longitudinal students, p=0.002). However, longitudinal students excelled in family medicine with significantly higher departmental final exam scores (79.9% vs 77.6%, p=0.016) and clerkship grades (32.3% honors for longitudinal students vs. 19.0% honors for traditional students, p=0.049). Finally, more longitudinal students matched in a primary care field (63.45% vs 41.4%, p=0.003).
Discussion: The longitudinal clerkship experience at JABSOM appears to provide a learning experience that strongly fosters interest in primary care, particularly family medicine. Longitudinal students performed exceptionally well on the family medicine exam and received higher clerkship grades on family medicine than students assigned to the traditional track. At baseline the longitudinal and traditional students had similar MCAT and Step 1 scores implying similar baseline test-taking ability. Both educational tracks seem to offer a comparable learning experience in regards to preparation for USMLE Step 2. Higher performance regarding students’ surgery clerkship grades and pediatric SHELF scores in the traditional track will require further investigation. We also plan to determine and report if pediatric shelf exam scores in the 2012-2013 class changed when we modified the timing of the longitudinal shelf exam to ensure that students completed all aspects of their clinical pediatric training prior to the exam.