Neurology Clerkship: Predictors of Objective Structured Clinical Examination and Shelf Performance

We sought to determine whether the following factors are associated with stronger performance on the medical school neurology clerkship: (1) structure of the outpatient rotation (working with a single general neurologist or multiple subspecialists), (2) dedicated shelf exam preparation, and (3) clerkships completed prior to neurology rotation.

A total of 439 Feinberg medical students between 2014 and 2016 were analyzed based on the 3 variables of interest listed above. Student performance was evaluated using the National Board of Medical Examiner shelf exam and Objective Structured Clinical Examination/standardized evaluation scores. Univariate and multivariate analyses were conducted.

The format of the 2-week outpatient rotation did not significantly affect shelf examination (P = .59), or standardized evaluation (P = .34) scores. Taking a shelf pre-test correlated with overall higher standardized evaluation scores (P < .01), and higher shelf examination scores (P < .01). No individual clerkship correlated with better performance; however, the total number of core clerkships was associated with higher shelf examination scores (P = .007). Each additional core clerkship taken prior to neurology was associated with 0.72 points greater shelf examination score.

Greater attending continuity did not appear to be associated with stronger performance perhaps due to a difference in types of cases observed. Students who took a practice shelf exam did better on both their shelf exam and standardized evaluation, suggesting that acquisition of knowledge translates to a better clinical performance. No individual clerkship offers an advantage, but rather it is the total number of clerkships that is correlated with stronger performance.