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Prolonged Delays for Research Training in Medical School are Associated with Poorer Subsequent Clinical Knowledge

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Abstract

Background

Complementary degree programs and research training are important alternative tracks in medical school that typically interrupt the traditional MD curriculum.

Objective

Examine effects of such a break on clinical knowledge after reentry into the MD curriculum.

Design

Retrospective cohort study.

Participants

Three hundred and two graduates of Mayo Medical School.

Main Measurements

Compared years of delay between the second and third years of medical school with third year clerkship grades, National Board of Medical Examiner’s (NBME) Subject Examinations, and United States Medical License Exam (USMLE) Step 2.

Main Results

258, 13, and 31 students spent 0, 1, or ≥3 years pursing research between the second and third year. Baseline measures of knowledge before matriculation and before the third year were similar between groups. Whereas a 1-year delay had no significant effect, a ≥3-year delay was associated with fewer clerkship honors and lower NBME Medicine, Pediatrics, and Psychiatry percentiles compared to no delay (all p < .05). Students with a ≥3-year delay had a 77% reduction in the odds of honors in Medicine. For each year of delay beyond 3, students’ third-year NBME Medicine, Neurology, Obstetrics and Gynecology, and Psychiatry scores decreased as did USMLE Step 2 scores (r = −.38 to −.50, p < .05).

Conclusions

Delays of ≥3 years between the second and third years of medical school are associated with lower grades and scores on clinical knowledge tests. Further research is needed to determine the optimal timing of research training and develop effective interventions to facilitate reentry into the medical school curriculum.

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REFERENCES

  1. Ebbert J. A retrospective evaluation of research in the medical curriculum. J Med Educ. 1960;35:637–43.

    PubMed  Google Scholar 

  2. Houlden RL, Raja JB, Collier CP, Clark AF, Waugh JM. Medical students’ perceptions of an undergraduate research elective. Med Teach. 2004;26(7):659–61.

    Article  PubMed  Google Scholar 

  3. Jacobs CD, Cross PC. The value of medical student research: the experience at Stanford University School of Medicine. Med Educ. 1995;29(5):342–6.

    Article  PubMed  CAS  Google Scholar 

  4. Frishman WH. Student research projects and theses: should they be a requirement for medical school graduation? Heart Dis. 2001;3(3):140–4.

    Article  PubMed  CAS  Google Scholar 

  5. Paiva RE, Donnelly C, Haley HB, Huynh H. Factors related to medical students’ research activities. J Med Educ. 1975;50(4):339–45.

    PubMed  CAS  Google Scholar 

  6. Davis WK, Kelley WN. Factors influencing decisions to enter careers in clinical investigation. J Med Educ. 1982;57(4):275–81.

    PubMed  CAS  Google Scholar 

  7. Segal S, Lloyd T, Houts PS, Stillman PL, Jungas RL, Greer RB, 3rd. The association between students’ research involvement in medical school and their postgraduate medical activities. Acad Med. 1990;65(8):530–3.

    Article  PubMed  CAS  Google Scholar 

  8. Brancati F, Mead LA, Levine D, Martin D, Margolis S, Klag M. Early predictors of career achievement in academic medicine. JAMA. 1992;267(10):1372–6.

    Article  PubMed  CAS  Google Scholar 

  9. NIGMS. The Careers and Professional Activities of Graduates of the NIGMS Medical Scientist Training Program. http://www.nih.gov/nigms/news/reports/mstpstudy/mstp-print.html. 1998;NIH Bethesda, Maryland.

  10. Association of American Medical Colleges. Educating Doctors to Provide High Quality Medical Care. A Vision for Medical Education in the United States. Report of the Ad Hoc Committee of Deans. 2004.

  11. Association of American Medical Colleges. Medical School Curriculum Directory http://services.aamc.org/currdir/start.cfm, accessed 3/10/2007).

  12. National Board of Medical Examiners. Subject Examination Program. Score Interpretation Guide. NBME Introduction to Clinical Diagnosis (ICD) Subject Test.

  13. National Board of Medical Examiners. Subject Examination Program. Score Interpretation Guide. NBME Medicine Subject Test.

  14. Hoffman KI. The USMLE, the NBME subject examinations, and assessment of individual academic achievement. Acad Med. 1993;68(10):740–7.

    Article  PubMed  CAS  Google Scholar 

  15. Conover WJ, Iman RL. Rank transformations as a bridge between parametric and nonparametric statistics. Am Stat. 1981;35:124–9.

    Article  Google Scholar 

  16. Wyngaarden JB. The clinical investigator as an endangered species. N Engl J Med. 1979;301(23):1254–9.

    Article  PubMed  CAS  Google Scholar 

  17. Morrison J. Evaluation. BMJ. 2003;326(7385):385–7.

    Article  PubMed  Google Scholar 

  18. Appel J, Friedman E, Fazio S, et al. Educational assessment guidelines: a Clerkship Directors in Internal Medicine commentary. Am J Med. 2002;113(2):172–9.

    Article  PubMed  Google Scholar 

  19. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226–35.

    Article  PubMed  Google Scholar 

  20. Edelstein RA, Reid HM, Usatine R, Wilkes MS. A comparative study of measures to evaluate medical students’ performance. Acad Med. 2000;75(8):825–33.

    Article  PubMed  CAS  Google Scholar 

  21. Wagoner NE, Suriano JR. Recommendations for changing the residency selection process based on a survey of program directors. Acad Med. 1992;67(7):459–65.

    Article  PubMed  CAS  Google Scholar 

  22. Galazka SS, Kikano GE, Zyzanski S. Methods of recruiting and selecting residents for U.S. family practice residencies. Acad Med. 1994;69(4):304–6.

    Article  PubMed  CAS  Google Scholar 

  23. Fine PL, Hayward RA. Do the criteria of resident selection committees predict residents’ performances? Acad Med. 1995;70(9):834–8.

    Article  PubMed  CAS  Google Scholar 

  24. Dirschl DR, Campion ER, Gilliam K. Resident selection and predictors of performance: can we be evidence based? Clin Orthop Relat Res. 2006;449:44–9.

    PubMed  Google Scholar 

  25. Crane JT, Ferraro CM. Selection criteria for emergency medicine residency applicants. Acad Emerg Med. 2000;7(1):54–60.

    PubMed  CAS  Google Scholar 

  26. Grantham JR. Radiology resident selection: results of a survey. Invest Radiol. 1993;28(1):99–101.

    Article  PubMed  CAS  Google Scholar 

  27. Calhoun KH, Hokanson JA, Bailey BJ. Predictors of residency performance: a follow-up study. Otolaryngol Head Neck Surg. 1997;116:647–51.

    Article  PubMed  CAS  Google Scholar 

  28. Wagoner NE, Suriano JR. Program directors’ responses to a survey on variables used to select residents in a time of change. Acad Med. 1999;74(1):51–8.

    Article  PubMed  CAS  Google Scholar 

  29. Wagoner NE, Suriano JR, Stoner JA. Factors used by program directors to select residents. J Med Educ. 1986;61(1):10–21.

    PubMed  CAS  Google Scholar 

  30. Bernstein AD, Jazrawi LM, Elbeshbeshy B, Della Valle CJ, Zuckerman JD. Orthopaedic resident-selection criteria. J Bone Jt Surg Am. Nov. 2002;84-A(11):2090–6.

    Google Scholar 

  31. Hamdy H, Prasad K, Anderson MB, et al. BEME systematic review: predictive values of measurements obtained in medical schools and future performance in medical practice. Med Teach. 2006;28(2):103–16.

    Article  PubMed  Google Scholar 

  32. Taylor ML, Blue AV, Mainous AG, 3rd, Geesey ME, Basco WT, Jr. The relationship between the National Board of Medical Examiners’ prototype of the Step 2 clinical skills exam and interns’ performance. Acad Med. 2005;80(5):496–501.

    Article  PubMed  Google Scholar 

  33. Boyse TD, Patterson SK, Cohan RH, et al. Does medical school performance predict radiology resident performance? Acad Radiol. 2002;9(4):437–45. Apr.

    Article  PubMed  Google Scholar 

  34. Amos DE, Massagli TL. Medical school achievements as predictors of performance in a physical medicine and rehabilitation residency. Acad Med. 1996;71(6):678–80.

    Article  PubMed  CAS  Google Scholar 

  35. Dirschl DRMD, Dahners LEMD, Adams GLBA, Crouch JHMS, Wilson FCMD. Correlating selection criteria with subsequent performance as residents. Clin Orthop Relat Res. 2002;399:265–74.

    Article  PubMed  Google Scholar 

  36. Hojat M, Robeson M, Damjanov I, Veloski JJ, Glaser K, Gonnella JS. Students’ psychosocial characteristics as predictors of academic performance in medical school. Acad Med. 1993;68(8):635–7.

    Article  PubMed  CAS  Google Scholar 

  37. Spiegel DA, Smolen RC, Hopfensperger KA. Medical student stress and clerkship performance. J Med Educ. 1986;61(11):929–31.

    PubMed  CAS  Google Scholar 

  38. Spiegel DA, Smolen RC, Jonas CK. An examination of the relationships among interpersonal stress, morale and academic performance in male and female medical students. Soc Sci Med. 1986;23(11):1157–61.

    Article  PubMed  CAS  Google Scholar 

  39. Ogunyemi D, Taylor-Harris D. Factors that correlate with the U.S. Medical Licensure Examination Step-2 scores in a diverse medical student population. J Natl Med Assoc. 2005;97(9):1258–62.

    PubMed  Google Scholar 

  40. Myles TD, Henderson RC. Medical licensure examination scores: relationship to obstetrics and gynecology examination scores. Obstet Gynecol. 2002;100(5 Pt 1):955–8.

    Article  PubMed  Google Scholar 

  41. Myles T, Galvez-Myles R. USMLE Step 1 and 2 scores correlate with family medicine clinical and examination scores. Fam Med. 2003;35(7):510–3.

    PubMed  Google Scholar 

  42. Andriole DA, Jeffe DB, Whelan AJ. What predicts surgical internship performance? Am J Surg. 2004;188(2):161–4.

    Article  PubMed  Google Scholar 

  43. Bell JF, Kanellitsas I, Shaffer L. Selection of obstetrics and gynecology residents on the basis of medical schoool performance. Am J Obstet Gynecol. 2002;186(5):1091–4.

    Article  PubMed  Google Scholar 

  44. Andriole DA, Jeffe DB, Hageman HL, Whelan A. What predicts USMLE Step 3 performance? Acad Med. 2005;80(10):S21–3.

    Article  PubMed  Google Scholar 

  45. Association of American Medical Colleges. Facts—Applicants, Matriculants, and Graduates http://www.aamc.org/data/facts/2004/2004mcatgpa.htm, accessed 3/10/2007); 2004.

  46. United States Medical Licensing Examination. Interperting USMLE Scores. http://www.usmle.org/FAQs/faqusmlescores.htm, accessed 3/10/2007).

  47. Williams RG. Use of NBME and USMLE examinations to evaluate medical education programs. Acad Med. 1993;68(10):748–52.

    Article  PubMed  CAS  Google Scholar 

  48. Lim JK, Golub RM. Graduate medical education research in the 21st century and JAMA on call. JAMA. 2004;292(23):2913–5.

    Article  PubMed  CAS  Google Scholar 

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ACKNOWLEDGMENT

The authors would like to thank Tanya Hoskin from the Mayo Clinic Center for Translational Science Activities (CTSA) Service Center for assistance with statistical analysis and Dr. Tait Shanafelt, Dr. Robert Tiegs, and Dr. Darcy Reed for their feedback on earlier drafts of the manuscript. Part of this work was presented at the Association of American Medical College’s Research in Medical Education and Clerkship Directors of Internal Medicine’s Annual conferences in 2005. Investigators received salary support from institutional sources, but these sources were not involved in the design of the study; in the collection, analysis, or interpretation of data; or in the decision to submit the manuscript for publication.

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55906, USA

    Liselotte N. Dyrbye MD, Matthew R. Thomas MD, Neena Natt MD & Charles H. Rohren MD

  2. Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55906, USA

    Liselotte N. Dyrbye MD

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  1. Liselotte N. Dyrbye MD
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  2. Matthew R. Thomas MD
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Correspondence to Liselotte N. Dyrbye MD.

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Dyrbye, L.N., Thomas, M.R., Natt, N. et al. Prolonged Delays for Research Training in Medical School are Associated with Poorer Subsequent Clinical Knowledge. J GEN INTERN MED 22, 1101–1106 (2007). https://doi.org/10.1007/s11606-007-0200-x

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