The effect of the duration and structure of a surgery clerkship on student performance

The emphasis on a generalist professional education has led to shortening and restructuring of the surgery clerkship in the curricula of many medical schools. Little data exist regarding the effect of these changes on student performance. Therefore, we examined the effect of the length, timing, and content of the third year surgery rotation on several clerkship and postclerkship performance measures of 487 students from July 1994 to July 1998. In addition, students' perceptions regarding their ability to understand surgical disease topics were surveyed. The 8-week clerkship (n = 232) was associated with higher NMBE surgery test scores (510.5 +/- 6.3 versus 457.4 +/- 10.0, P < 0.05) resulting in higher final clerkship grades (5.15 +/- 0.04 versus 4.87 +/- 0.03, P < 0.05). Although clerkship length had no significant effect on USMLE step 2 total or surgery subsection scores, the longer clerkship was associated with higher total (70.6 +/- 0.37 versus 68. 8 +/- 0.50, P < 0.05) and abdominal pain station (81.87 +/- 0.71 versus 79.54 +/- 0.73, P < 0.05) OCSE scores. Students rotating on surgery during the second half of third year (n = 233) had higher NMBE surgery test scores (513.1 +/- 8.9 versus 460.5 +/- 11.2, P < 0. 05) and final grades (5.17 +/- 0.03 versus 4.81 +/- 0.04, P < 0.05). Although the timing of the surgery clerkship did not significantly affect total OSCE scores, students who rotated on surgery in the second half of third year performed significantly better year on the abdominal pain OSCE station (80.47 +/- 0.92 versus 76.49 +/- 1.27, P < 0.05). Students who rotated on general surgery (n = 298) performed significantly better on the NBME surgery test (525.6 +/- 6.0 versus 459.6 +/- 9.1, P < 0.05), although this did not significantly affect the final grade. Although general versus subspecialty surgery rotation did not significantly affect total OSCE scores, students rotating on general surgery performed significantly better on the abdominal pain OSCE station (81.21 +/- 0.91 versus 78.17 +/- 0.32, P < 0.05). The length, timing, and content of the third year surgery rotation had no significant effect on performance on the oral examination. Students who had a 6-week clerkship and students who lacked exposure to general surgery felt their surgery rotation failed to prepare them to understand a number of surgical topics as well as students who had an 8-week clerkship or students who rotated on general surgery. The length, timing, and content of the surgery clerkship affect some clerkship performance measures and student perceptions of their understanding of surgical disease topics. While cognitive differences related to clerkship length are no longer detectable at the end of the third year of medical school, differences related to the acquisition of some clinical skills persist after the surgery clerkship.