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Subbing in: Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes.
Alyssa L MacMahon1, Meaghan S Wido1, Steven J Durning2
1Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD USA.
Medical Science Educator
|May 25, 2026
Summary
Medical students increasingly use screen-based simulations for clinical experiences. While substitutions rose post-2020, they showed minimal impact on National Board of Medical Examiners (NBME) scores, suggesting simulation remains a viable alternative.
Area of Science:
- Medical Education
- Clinical Reasoning Development
- Simulation in Healthcare
Background:
- Clinical experiences are crucial for medical students' clinical reasoning and professional identity.
- Screen-based simulations are often used when real patient encounters are unavailable.
- Clarity is needed on the frequency, type, and impact of simulation substitutions on clinical competencies.
Purpose of the Study:
- To quantify trends in screen-based simulation substitutions during pediatric clerkships.
- To investigate the association between these substitutions and student performance outcomes.
Main Methods:
- Retrospective analysis of 884 medical students' records from 2018-2023.
- Data included tracked clinical experiences, National Board of Medical Examiners (NBME) Pediatrics Subject exam scores, and History and Physical (H&P) exam performance.
- Descriptive statistics and regression analyses were used to assess substitution trends and their relationship with outcomes.
Main Results:
- Students substituted an average of 0.79 out of 12 required experiences, with 'Acute Gastroenteritis' being frequently replaced.
- Substitutions significantly increased in 2020 compared to prior years.
- A small negative correlation was found between substitutions and NBME scores (p<0.05), but no significant link to H&P scores.
Conclusions:
- The rise in screen-based substitutions since 2020 warrants attention regarding potential limitations in core clinical exposure.
- The minimal association with performance outcomes suggests screen-based simulations are a reasonable alternative for clinical experience substitution.
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