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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.
Background:
Clinical experiences foster medical students' clinical reasoning and professional identity. When real patient encounters are not available, students often utilize screen-based simulation. While screen-based substitutions can be a comparable alternative (Meyer et al. Acad Psychiatry 47:181-186, 2023; Patel et al. Cureus 16:e54541, 2024), there is less clarity regarding frequency and type of experiences students substitute with simulation and how this relates to clinical competencies.
Objective:
This retrospective study seeks to quantify the trends of screen-based substitutions among pediatric clerkship students and investigate associations between substitutions and performance outcomes.
Methods:
Data were collected from the Uniformed Services University, Department of Pediatrics archival records (2018-2023) of students (N = 884) tracked clinical experiences, scores on the National Board of Medical Examiners ® (NBME) Pediatrics Subject exam, and a written History and Physical (H&P) exam. Analysis included descriptive statistics of clinical substitutions by type, location, and over time. Regression analysis compared the number of substitutions and performance outcomes.
Results:
Students substituted a mean of 0.79 (SD = 1.08) out of the 12 required clinical experiences. Acute Gastroenteritis was consistently and frequently substituted. Overall, substitutions increased significantly in 2020 compared to 2018 and 2019. There was a small but significant negative relationship between number of substitutions and NBME scores (β = -.06, p < .05), but no significant relationship with H&P scores (β = .02, p = .40).
Conclusion:
Increased use of substitutions since 2020 raises concerns about limitations in students' exposure to core clinical experiences. However, the minimal association between substitutions and performance outcomes suggests screen-based substitutions are still a reasonable alternative.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s40670-026-02651-5.
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