Combined Ambulatory and Inpatient Pediatric Clerkship Leads to Higher Shelf Scores and Improved Student Preparedness

Data are lacking on the effect of pediatric clerkship duration on National Board of Medical Examiners pediatric shelf examination scores. Our school has recently changed its clerkship structure, transitioning from separate ambulatory and inpatient clerkships with examination at the end of each clerkship to a combined 8-week ambulatory and inpatient clerkship with a single examination. We hypothesized that students in the split model would score higher on their second shelf attempt and ambulatory students would score higher than those with inpatient first. We hypothesized that the combined clerkship model would yield higher shelf scores than aggregate scores in the split model.

Examination scores for the split versus combined clerkship model were analyzed. Students completed surveys assessing their comfort caring for pediatric patients before and after the change in clerkship structure.

Students from the split (n = 361) and combined (n = 250) models were analyzed. For the survey, 110 students (44%) responded from the split model and 193 (77%) from the combined model. Combined model had statistically significant (P < 0.05) higher National Board of Medical Examiners scores than the split model. This was driven by a lower score (P < 0.001) on the second attempt compared with combined or the first time. Students who took inpatient first scored significantly higher than those who took ambulatory first in the split model. Surveys showed significantly higher comfort (P < 0.05) in the combined clerkship.

Understanding how to maximize student comfort caring for pediatric patients and scores on the shelf examination are important for curriculum design and for continuing to attract students to the specialty.