Effect of clinical teaching on student performance during a medicine clerkship

To measure what proportion of student clerkship performance can be attributed to teachers' educational skills as reported by students.

From August 1992 to June 1994, we collected critiques of teacher skills from 314 third-year students at the end of a 12-week medicine clerkship. Interns, residents, attending physicians, and student preceptors were rated (on a 1 to 5 scale) on teaching behaviors from the 7 categories of the Stanford Faculty Development Program framework. A linear regression model was used to determine the relative contributions of the rated teaching behaviors in predicting final student performance and improvement across the clerkship ("student growth"), measured using end-of-clerkship variables (clinical grades, National Board of Medical Examiners medicine shelf examination, practical laboratory examination, and an analytical essay examination) and preclerkship variables (pre-third-year grade point average [GPA], United States Medical Licensing Examination, Step I, and clerkship pretest).

Data were available for 293 (93%) of 314 students, who completed a total of 2,817 critiques. The students' preclerkship GPA accounted for the greatest percentage of variance in student performance (28%, P < 0.0001). Clinical teaching behaviors accounted for an additional 6% (P < 0.0001) of the variance. For student growth across the clerkship, teaching accounted for 10% of the variance (P < 0.0001). Among the 7 Stanford educational categories, teaching behaviors promoting control of session (r2 = 5%, P = 0.0002) and fostering understanding and retention (r2 = 4%, P = 0.001) had the greatest effect. The resident had the most effect on student growth (r2 = 6%, P = 0.0001) when compared with other teaching levels. Teaching had a greater effect on growth for students with preclerkship GPA above the mean (16% versus 6%), for older students (24% versus 7%), and for students with a nonscience undergraduate degree (33% versus 9%).

The preclerkship GPA, reflecting 2 years of work, was the most important predictor of student performance. Teaching behavior, as measured by student assessments, also affected student performance.