Clinical lectures that do not require prior preparation are of limited value

The objective of this study was to determine whether requiring students to intensively prepare for clinical lectures resulted in improved scores on the National Board of Medical Examiners (NBME) Subject Examination in Obstetrics and Gynecology (subject examination). A new curriculum was developed for the class of 2000/2001 at the Medical College of Ohio. The curriculum required that students, prior to attending clinical lectures, do required reading tested by a take-home test and an in-class quiz. The performances on the subject examination for the classes of 1998/1999 and 2000/2001 were compared. This was done as a cohort study controlling for previous NBME Step I performance, educational site, and timing of the clerkship in the academic year. The 2000/01 class had raw scores 5.7 points higher on average (71.3 versus 65.6). For students in Area Health Education Centers (AHEC) off campus, who attended only half the lectures, the average score was 3 points lower in 1999, p < 0.020. In 2000, these students were required to prepare for take-home examinations and quizzes the same as in-town students, and there was no significant difference between AHEC and in-town students who attended all of the lecture series. We conclude that students have better retention and understanding of clinical information if they prepare prior to lectures. Timely self-directed learning throughout the clerkship offers an advantage over cramming in the final weeks. The timely preparation was more important than the lecture exposure for these sophisticated adult learners.