Clinical clerkship timing revisited: Support for non-uniform sequencing

The logistical necessity of students taking required clinical clerkship rotations in non-uniform sequences may have significant consequences on performance.

To investigate (1) the impact of previous clinical clerkship experience and the national licensing examination (USMLE Step 1) rankings on end-of-clerkship overall skills assessments and (2) the effect of clinical clerkship order on end-of-year objective structured clinical examination (OSCE) performance.

The core clinical phase of UCLA consists at six clinical clerkships during a 48-week continuum. The clerkships are structured in two different tracks with different rotation order. Clinical performance scores were analyzed for 124 year-3 students in the two different tracks.

Performance, as reviewed on a standardized clinical clerkship evaluation form by faculty and residents, improved significantly across the clinical year, regardless of track suggesting an accumulated advantage of previous experiences. There were no significant differences between tracks on the OSCE.

Overall clinical skills are more directly impacted by the time-of-year and not order whereas knowledge of specific specialties may be impacted by the order rotations that are taken. While this may not be obvious to students, perhaps we should share these results for their use in tracking their personal growth in clinical skills.