How Much Time is Enough? Evaluating Clinical Performance in a Time-Variable Internal Medicine Clerkship

The length of internal medicine (IM) clerkships has decreased over time, with unclear impact on clinical performance metrics. The ORIME (Observer-Reporter-Interpreter-Manager-Educator) framework was used to assess the impact of different IM clerkship lengths and how completion of prior clerkships affected students' IM clinical performance.

Between 1/25/21 and 3/22/24, physician evaluators rated clerkship students' clinical performance using the ORIME scale (Scale: 1 = Observer/Pre-Reporter; 2 = Reporter; 3 = Interpreter; 4 = Manager). Comparisons were made between final ORIME scores for students in four- and eight-week versions of the clerkship, as well as for cumulative clinical exposure time across IM-aligned specialties and all specialties.

Of the 179 third-year medical students participating in the study, 119 (66.5%) completed the 4-week clerkship, and 60 (33.5%) completed the 8-week clerkship.

The mean ORIME score was 2.70 (SD = 0.42) for students undertaking the 4-week clerkship and 2.87 (SD = 0.38) for students in the 8-week clerkship (p = 0.01; Cohen's d = 0.41). Students in the 8-week clerkship achieved Interpreter level (ORIME = 3.0) after 8 weeks of prior IM-aligned or 12 weeks of any prior clinical exposure. Students in the 4-week clerkship achieved Interpreter level after 12 to 16 weeks of prior IM-aligned or 24 to 28 weeks of any prior clinical exposure.

Medical students achieved Interpreter level with an average of 16 to 20 weeks of cumulative clinical exposure to IM-aligned specialties. Students enrolled in the 8-week version of the clerkship achieved Interpreter level more rapidly than students in the 4-week version, suggesting that continuity in IM training is impactful.