Prematriculation Healthcare Employment Predicts Success in Clerkship Environment

  • Lindsay C. StrowdEmail author
  • Hong Gao
  • Mary Claire O’Brien
  • Cynthia Burns
  • Julie A. Freischlag
  • Roy E. Strowd
  • David Grier
  • Timothy R. Peters
Original Research



The average age of the matriculating medical student is increasing as more students take time between college and medical school. Increasing numbers of students are employed in the healthcare field during these gap years. Studies have explored the relationship between matriculation age and medical school performance with conflicting findings. The impact of prior healthcare employment (PHE) on future clerkship performance has not been explored. We hypothesize that medical school performance metrics would be higher for students with PHE than their peers.


A retrospective review of four medical school classes at a single institution was conducted. Each student’s admission application was examined to identify students with at least 6 months paid employment in a clinical healthcare position (i.e., pre-matriculation direct patient interaction, PHE cohort). Multiple medical school performance metrics were obtained for each student.


Of the 434 included students, 49 were PHE (11.29%) and percent of students with PHE trended up over time. MCAT scores, USMLE Step 1, and Step 2 CK scores were not different for PHE and non-PHE medical students. PHE students had significantly higher NBME subject exams, clinical clerkship scores, and cumulative year 3 performance.


Students who matriculate to medical school with prior healthcare employment outperform their peers in the clinical environment, possibly due to acquisition of knowledge or skills from their prior employment. These findings support students seeking paid healthcare experiences prior to medical school and have implications for pre-medicine advising, admissions, and medical school curricula.


Medical school admissions Prior healthcare employment Clerkship performance 


Funding Information

Dr. Strowd has received medical education scholarship support from the Brooks Scholarship, an institutional scholarship awarded through Wake Forest University School of Medicine.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Wake Forest School of Medicine IRB. IRB00043836.


The authors have no disclaimers.


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Copyright information

© International Association of Medical Science Educators 2019

Authors and Affiliations

  1. 1.Department of DermatologyWake Forest University School of MedicineWinston-SalemUSA
  2. 2.Department of Internal MedicineWake Forest University School of MedicineWinston-SalemUSA
  3. 3.Departments of Emergency Medicine and Healthcare EducationWake Forest University School of MedicineWinston-SalemUSA
  4. 4.Department of Internal Medicine, Section of EndocrinologyWake Forest University School of MedicineWinston-SalemUSA
  5. 5.Department of Vascular SurgeryWake Forest Baptist HealthWinston-SalemUSA
  6. 6.School of MedicineWake Forest UniversityWinston-SalemUSA
  7. 7.Department of Neurology and OncologyWake Forest University School of MedicineWinston-SalemUSA
  8. 8.Department of Pathology and Laboratory MedicineUniversity of Cincinnati School of MedicineCincinnatiUSA
  9. 9.Departments of Pediatrics and Education Strategy and InnovationWake Forest University School of MedicineWinston-SalemUSA

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