Assessing the impact of clerkships on the growth of clinical knowledge.

Purpose: This study quantified the impact of clinical clerkships on medical students' disciplinary knowledge using the Comprehensive Clinical Science Examination (CCSE) as a formative assessment tool.

Methods: This study involved 155 third-year medical students in the College of Human Medicine at Michigan State University who matriculated in 2016. Disciplinary scores on their individual Comprehensive Clinical Science Examination reports were extracted by digitizing the bar charts using image processing techniques. Segmented regression analysis was used to quantify the differences in disciplinary knowledge before, during, and after clerkships in five disciplines: surgery, internal medicine, psychiatry, pediatrics, and obstetrics and gynecology (ob/gyn).

Results: A comparison of the regression intercepts before and during their clerkships revealed that, on average, the participants improved the most in ob/gyn ($\beta =$11.193, p$<$.0001), followed by psychiatry ($\beta =$10.005, p$<$.001), pediatrics ($\beta =$6.238, p$<$.0001), internal medicine ($\beta =$1.638, p$=$.30), and improved the least in surgery ($\beta =$-2.332, p$=$.10). The regression intercepts of knowledge during their clerkships and after them, on the other hand, suggested that students' average scores improved the most in psychiatry ($\beta =$7.649, p$=$.008), followed by ob/gyn ($\beta =$4.175, p$=$.06), surgery ($\beta =$4.106, p$=$.007), and pediatrics ($\beta =$1.732, p$=$.32).

Conclusions: These findings highlight how clerkships influence the acquisition of disciplinary knowledge, offering valuable insights for curriculum design and assessment. This approach can be adapted to evaluate the effectiveness of other curricular activities, such as tutoring or intersessions. The results have significant implications for educators revising clerkship content and for students preparing for the United States Medical Licensing Examination Step 2.