Evaluation of academic and community surgery clerkships at a Midwestern medical school

The equivalency of surgical clerkship experience between academic and community sites is an issue that is assessed with difficulty. We examined the objective performance of 222 medical students after completion of the 8-week surgical clerkship. Six different consecutive semesters were analyzed. There were two objective examinations reviewed, the National Board of Medical Examiners' subject examination and the surgical subportion of the Objective Structured Clinical Examination (OSCE) given at the end of the third year.

Medical students were classified into three separate groups based on the site of their surgical clerkship. The medical students were in either academic (100), community (79), or combined (academic and community) (43) locations. Medical student performance on the subject examination and OSCE was examined after completion of the general surgical clerkship. Single-factor analysis of variance testing was done to compare each of the three groups with respect to subject examination test score, or OSCE score. Significance was defined as P < 0.05.

The combined group scored highest on the subject examination (73.6%). The community group scored highest on the OSCE (80.7%). However, no statistical significance exists between the three groups with regard to subject examination (P = NS) or OSCE (P= NS). Subject examination scores did not correlate with OSCE scores (r = 0.095). Objective measurements of surgical subject examination and OSCE were not statistically different between academic, community, and academic and community surgical clerkship participants.

No statistically significant differences exist between the three groups with regards to OSCE failure rates, but the small amount of failures may have caused Type 2 error. Surgical clinical skills as tested by an OSCE and surgical knowledge as tested by a subject examination are equally attained by an academic or community surgical clerkship.