Time Does Matter: Reduced Internal Medicine Clerkship Clinical Experiences Due to COVID-19

Introduction The coronavirus disease 2019 (COVID-19) pandemic has affected medical education in many ways. The Association of American Medical Colleges (AAMC) temporarily suspended clinical student rotations, calling for a transition to remote learning. Unfortunately, due to the heavy impact of COVID-19 in our South Florida community, medical students were not able to return to in-person activities for a significant time. During this period, students had remote clerkship learning activities, didactic sessions, narrative projects, and small-group learning sessions, which were front-loaded using Zoom technology (Zoom Video Communications, Inc., San Jose, California, United States) and web-based learning tools. Once in-person clinical experiences resumed, the duration of all third-year clerkships for the remainder of the year was reduced to five weeks to allow for timely graduation. The Herbert Wertheim College of Medicine (HWCOM) Internal Medicine (IM) clerkship has traditionally been an eight-week-long rotation. Other clerkships that varied from six to eight weeks were similarly reduced to five weeks. We hypothesized that the shortened duration of the IM clerkship would have negative impacts on National Board of Medical Examiners (NBME) exam performance and clerkship clinical experiences would likely be affected. Methods We compared the NBME subject exam results and end of clerkship evaluations from the Class of 2021 (CO2021) which had the traditional eight weeks of patient care, with the CO2022, which had only five weeks of in-person patient care. A T-test analysis was performed comparing performance on the NBME medicine clinical subject exam between students who completed the usual eight-week rotation versus those who completed a five-week rotation. We also evaluated the IM clerkship course evaluation and analyzed student responses and ratings to assess any areas that were statistically significant when comparing the traditional eight-week IM clerkship to the shortened five-week clerkship. Results There was no statistically significant difference (t=0.68, p<0.4951) in mean NBME subject exam performance between cohorts. Students who completed the shortened five-week IM clerkship indicated there was limited volume and diversity of patients, which consequently affected their ability to complete all the required clinical experiences for the IM clerkship. These results indicated a statistically significant difference between the two cohorts (t =3.33, p<.001). Conclusion Students with shortened IM clerkship clinical care time (five weeks) were found to have no significant statistical differences in NBME subject exam performance compared to the traditional eight-week cohorts. However, students felt there was a decreased volume and diversity of patients, and they reported greater difficulties in completing the required clinical experiences, with diminished clinical confidence. Time does matter, and clinical time is very valuable for a student's undergraduate medical education. If another pandemic were to arise, the duration of different clerkships should be carefully assessed and individualized, and methods to assess and reclaim lost clinical time during the advanced clinical and postgraduate years should be considered.