Purpose

1. HOW THE QUANTITY OF PATIENT INTERACTIONS DURING THIRD-YEAR CLERKSHIPS AFFECTS MEDICAL STUDENT PERFORMANCE Rachel Whitaker Elam, ScM; Andria Thomas, PhD; Jake London, MBA Education Discovery Institute Medical College of Georgia at Georgia Health Sciences University, Augusta, GA Purpose Results, continued To conduct an exploratory analysis of the relationship between quantity of patient interactions during core third-year clerkships and performance on both national objective tests and faculty evaluations of junior medical students at GHSU’s Medical College of Georgia between academic year 2007 and 2011. • Controlling for clerkship (specialty type & order of rotations), Step 1 score, age, and gender: • JMS who logged fewer patient interactions than their peers (<1 sd) showed a statistically significant decrease in scores on the Step 2 CK and the NBME shelf exam of 3.64 and 1.86 points, respectively • JMS who logged more patient interactions than their peers (>1 sd) showed a statistically significant increase in faculty evaluation scores by 1.93 points Method Results • Junior medical students (JMS) are instructed to log all patient encounters (patient demographics, primary and secondary diagnoses, & resources utilized) for each of their core clerkships in the SPEL (Student Patient Encounter Log) database; the minimum mandatory number of logs varies by clerkship (see table below) • With IRB approval, we extracted de-identified data on JMS from 5 consecutive years (2007-2011), including demographics of age and gender as well as: • Number of Patient Interactions logged in SPEL • National objective performance scores: NBME shelf exam scores, USMLE Step 1 & 2 CK scores • Faculty evaluation scores on a 24-item form used in all clerkships with subscales for all 6 ACGME Core Competencies (cumulative score range 24-96) • We used regression analysis to explore the relationship between quantity of patient interactions and objective performances (NBME & Step 2 CK scores) and faculty evaluation scores , controlling for clerkship, Step 1, age, and gender • We considered a • p-value ≤ 0.05 • to be statistically • significant • We included 842 junior medical students’ records (JMS has complete record for age, gender and patients logged, & at least one other variable of interest) • 6,406 faculty evaluations included (Chronbach’s α between 0.70-0.89 for each of 6 ACGME competency subscales) Discussion/Conclusions • Exploratory analysis reveals that for JMS, an increased numbers of patient interactions logged in SPEL • is associated with better performance perceived by faculty, reflected in higher evaluation scores, and • is not associated with an improvement on national objective exams (NBME shelf exams or Step 2 CK) • Also, a decreased numbers of patient interactions logged • is associated with underperformance on objective exams (NBME shelf exams and Step 2 CK), and • is not associated with poorer performance perceived by faculty, reflected in lower evaluation scores • While the associations are statistically significant, their magnitude is small and practical significance is debatable • Further studies are need in order to elucidate • the directionalityof the associations found, and • the validity of ‘quantity of patient logged’ as a measure of clinical experience (needed to generalize the results) • We grouped number of patients logged [1 sd below the mean (μ); within 1 sd of μ; 1 sd above μ] for each clerkship to facilitate interpretation of regression • An * indicates a statistically significant difference in the regression analysis within each clerkship strata . Presented at the Research in Medical Education Session at the Association of American Medical Colleges Annual Meeting, Denver, CO 11/07/2011