Does performance on the NBME part II medicine examination when used as a clerkship examination reflect knowledge acquired during the medicine clerkship?

Objective:The purpose of this study was to examine whether the National Board of Medical Examiners (NBME) Medicine Examination provides a reasonable assessment tool for testing students’ knowledge acquired during a medicine clerkship. Design:Comparison of the performances of two classes of medical students on the NBME Part II Medicine Examination on the first and last days of 12-week medicine clerkships in a two-year period (1985–87). Participants:176 medical students in two consecutive classes at the Oregon Health Sciences University. Measurements and results:There was no significant difference in students’ performances on the NBME Part II Medicine Examination on the first day of the medicine clerkship, regardless of the quarter in which they took the clerkship. Prior clerkship experiences did not appear to influence the baseline pre-clerkship internal medicine knowledge base as defined by NBME Part II Medicine Examination performances. Students in the second half of the year, however, demonstrated greater gains in post-clerkship NBME Part II Medicine Examination performances than did their counterparts from the first half of the year, despite similar pre-clerkship testing performances. Received from the Division of General Internal Medicine, Oregon Health Sciences University, Portland VA Medical Center, Portland, Oregon. Presented in part at the January 1990 Northwest Regional Meeting of the Society of General Internal Medicine, Seattle, Washington.     

Impact of the Foundations of Clinical Medicine Course on USMLE Scores

BACKGROUND  The synthesis of basic and clinical science knowledge during the clerkship years has failed to meet educational expectations. OBJECTIVES  We hypothesized that a small-group course emphasizing the basic science underpinnings of disease, Foundations of Clinical Medicine (FCM), could be integrated into third year clerkships and would not negatively impact the United States Medical Licensure Examination (USMLE) step 2 scores. DESIGN  In 2001–2002, all third year students met weekly in groups of 8–12 clustered within clerkships to discuss the clinical and basic science aspects of prescribed, discipline-specific cases. PARTICIPANTS  Students completing USMLE step 2 between 1999 and 2004 (n = 743). MEASUREMENTS  Course evaluations were compared with the overall institutional average. Bivariate analyses compared the mean USMLE steps 1 and 2 scores across pre- and post-FCM student cohorts. We used multiple linear regression to assess the association between USMLE step 2 scores and FCM cohort controlling for potential confounders. RESULTS  Students’ average course evaluation score rose from 66 to 77 (2001–2004) compared to an institutional average of 73. The unadjusted mean USMLE step 1 score was higher for the post-FCM cohort (212.9 vs 207.5, respectively, p < .001) and associated with step 2 scores (estimated coefficient = 0.70, p < .001). Post-FCM cohort (2002–2004; n = 361) mean step 2 scores topped pre-FCM (1999–2001; n = 382) scores (215.9 vs 207.7, respectively, p < .001). FCM cohort remained a significant predictor of higher step 2 scores after adjustment for USMLE step 1 and demographic characteristics (estimated coefficient = 4.3, p = .002). CONCLUSIONS  A curriculum integrating clinical and basic sciences during third year clerkships is feasible and associated with improvement in standardized testing. Electronic supplementary material  The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

Association Between Hand-off Patients and Subject Exam Performance in Medicine Clerkship Students

BACKGROUND  Teaching hospitals increasingly rely on transfers of patient care to another physician (hand-offs) to comply with duty hour restrictions. Little is known about the impact of hand-offs on medical students. OBJECTIVE  To evaluate the impact of hand-offs on the types of patients students see and the association with their subsequent Medicine Subject Exam performance. DESIGN  Observational study over 1 year. PARTICIPANTS  Third-year medical students in an Inpatient Medicine Clerkship at five hospitals with night float systems. MEASUREMENTS  Primary outcome: Medicine Subject Exam at the end of the clerkship; explanatory variables: number of fresh (without prior evaluation) and hand-off patients, diagnoses, subspecialty patients, and full evaluations performed during the clerkship, and United Stated Medical Licensing Examination (USMLE) Step I scores. MAIN RESULTS  Of the 2,288 patients followed by 89 students, 990 (43.3%) were hand-offs. In a linear regression model, the only variables significantly associated with students’ Subject Exam percentile rankings were USMLE Step I scores (B = 0.26, P < 0.001) and the number of full evaluations completed on fresh patients (B =0.20,  P = 0.048; model r ² = 0.58). In other words, for each additional fresh patient evaluated, Subject Exam percentile rankings increased 0.2 points. For students in the highest quartile of Subject Exam percentile rankings, only Step I scores showed a significant association (B = 0.22, P = 0.002; r ² = 0.5). For students in the lowest quartile, only fresh patient evaluations demonstrated a significant association (B = 0.27, P = 0.03; r ² = 0.34). CONCLUSIONS  Hand-offs constitute a substantial portion of students’ patients and may have less educational value than “fresh” patients, especially for lower performing students. An abstract from this paper was presented at the Clerkship Directors in Internal Medicine National Conference in October 2007 and is published in the proceedings of that conference.     

The effect of testing time on students’ performance for the subject examination for internal medicine

The authors tested the hypothesis that increasing the allotted testing time from two to four hours for the National Board of Medical Examiners medicine subject examination would increase the score on this examination when given as part of the clerkship evaluation. One-hundred six students who completed their medicine clerkships between September 1991 and August 1992 (group 1) were compared with 96 students who completed their clerkships between September 1992 and August 1993 (group 2). The mean medicine subject examination score for group 1 was 462±86, vs 518±108 for group 2 (p=0.0003). Regression analysis using the medicine subject examination score as the dependent variable and all baseline characteristics, group assignment, and time of year the test was taken as independent variables demonstrated significant interactions only for United States Medical Licensing Examination (USMLE) Step 1 score (R²=0.48, β weight=0.68, p=0.0000) and group assignment (R²=0.05, β weight=0.18, p=0.002). The authors conclude that increased testing time for the medicine subject examination from two to four hours is associated with a significant increase in scores; however, scores on the preclinical USMLE Step 1 showed a stronger association. Received from the Department of Medicine and Office of Medical Education Research and Development, Michigan State University, East Lansing, Michigan.     

Long-term Retention of Smoking Cessation Counseling Skills Learned in the First Year of Medical School

Background Tobacco use is a significant cause of preventable morbidity and mortality in the United States, yet clinicians underutilize smoking cessation counseling. Medical schools are increasingly including training for smoking cessation skills in preclinical curricula. Information about long-term retention of these skills is needed. Objective To assess retention of smoking cessation counseling skills learned in the first year of medical school. Design Retrospective review of data collected for routine student and curriculum assessment. Participants Two cohorts of medical students at the University of Connecticut School of Medicine (total N = 112) in 1999–2001 and 2002–2004. Measurements and Main Results Scores by standardized patients were compared from first and fourth-year assessments, based on checklist items corresponding to the 5 strategies recommended by the U.S. Public Health Service (Ask, Advise, Assess, Assist, Arrange). In study cases, 97% of first-year students “asked” about smoking and retained this skill in fourth year (p = .08). Ninety-four percent of first-year students “assessed” readiness to quit and retained this skill (p = .21). Ninety-six percent of first-year students “advised” smokers to quit and retained this skill (p = .18). Eighty-six percent of first year students “assisted” smokers in quitting and retained this skill (p = 0.10). Eighty-one percent of first year students “arranged” follow-up contact and performance of this strategy improved in the fourth year to 91% (p = .03). Conclusions Smoking cessation counseling skills demonstrated by first year medical students were, with brief formal reinforcement in the third year, well retained into the fourth year of medical school. It is appropriate to begin this training early in medical education.     

US Medical Student Performance on the NBME Subject Examination in Internal Medicine: Do Clerkship Sequence and Clerkship Length Matter?

BACKGROUND

Prior to graduation, US medical students are required to complete clinical clerkship rotations, most commonly in the specialty areas of family medicine, internal medicine, obstetrics and gynecology (ob/gyn), pediatrics, psychiatry, and surgery. Within a school, the sequence in which students complete these clerkships varies. In addition, the length of these rotations varies, both within a school for different clerkships and between schools for the same clerkship.

OBJECTIVE

The present study investigated the effects of clerkship sequence and length on performance on the National Board of Medical Examiner’s subject examination in internal medicine.

PARTICIPANTS

The study sample included 16,091 students from 67 US Liaison Committee on Medical Education (LCME)-accredited medical schools who graduated in 2012 or 2013.

MAIN MEASURES

Student-level measures included first-attempt internal medicine subject examination scores, first-attempt USMLE Step 1 scores, and five dichotomous variables capturing whether or not students completed rotations in family medicine, ob/gyn, pediatrics, psychiatry, and surgery prior to taking the internal medicine rotation. School-level measures included clerkship length and average Step 1 score.

DESIGN

Multilevel models with students nested in schools were estimated with internal medicine subject examination scores as the dependent measure. Step 1 scores and the five dichotomous variables were treated as student-level predictors. Internal medicine clerkship length and average Step 1 score were used to predict school-to-school variation in average internal medicine subject examination scores.

KEY RESULTS

Completion of rotations in surgery, pediatrics and family medicine prior to taking the internal medicine examination significantly improved scores, with the largest benefit observed for surgery (coefficient = 1.58 points; p value < 0.01); completion of rotations in ob/gyn and psychiatry were unrelated to internal medicine subject examination performance. At the school level, longer internal medicine clerkships were associated with higher scores on the internal medicine examination (coefficient = 0.23 points/week; p value < 0.01).

CONCLUSIONS

The order in which students complete clinical clerkships and the length of the internal medicine clerkship are associated with their internal medicine subject examination scores. Findings may have implications for curriculum re-design.KEY WORDS: clinical education, internal medicine clerkship performance, clerkship sequence, clerkship length, NBME subject examinations     

Impact of a Pre-Clinical Clinical Skills Curriculum on Student Performance in Third-Year Clerkships

BACKGROUND  Research on the outcomes of pre-clinical curricula for clinical skills development is needed to assess their influence on medical student performance in clerkships. OBJECTIVE  To better understand the impact of a clinical-skills curriculum in the pre-clinical setting on student performance. DESIGN  We conducted a non-randomized, retrospective, pre-post review of student performance evaluations from 3rd-year clerkships, before and after implementation of a clinical-skills curriculum, the Colleges (2001–2007). MAIN RESULTS  Comparisons of clerkship performance data revealed statistically significant differences favoring the post-Colleges group in the Internal Medicine clerkship for 9 of 12 clinical-skills domains, including Technical Communication Skills (p < 0.023, effect size 0.16), Procedural Skills (p < 0.031, effect size 0.17), Communication Skills (p < 0.003, effect size 0.21), Patient Relationships (p < 0.003, effect size 0.21), Professional Relationships (p < 0.021, effect size 0.17), Educational Attitudes (p < 0.001, effect size 0.24), Initiative and Interest (p < 0.032, effect size 0.15), Attendance and Participation (p < 0.007, effect size 0.19), and Dependability (p < 0.008, effect size 0.19). Statistically significant differences were identified favoring the post-Colleges group in technical communication skills for three of six basic clerkships (Internal Medicine, Surgery, and Pediatrics). CONCLUSIONS  Implementation of a pre-clinical fundamental skills curriculum appears to be associated with improved clerkship performance in the 3rd year of medical school, particularly in the Internal Medicine clerkship. Similar curricula, focused on teaching clinical skills in small groups at the bedside with personalized mentoring from faculty members, may improve student performance. Continued efforts are needed to understand how to best prepare students for clinical clerkships and how to evaluate outcomes of similar pre-clinical skills programs.     

Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study

Background  Evidence-based medicine (EBM) is increasingly taught in medical schools, but few curricula have been evaluated using validated instruments. Objective  To evaluate a longitudinal medical school EBM curriculum using a validated instrument. Design, Participants, Measurements  We evaluated EBM attitudes and knowledge of 32 medical students as they progressed through an EBM curriculum. The first part was an EBM “short course” with didactic and small-group sessions occurring at the end of the second year. The second part integrated EBM assignments with third-year clinical rotations. The validated 15-item Berlin Questionnaire was administered before the course, after the short course, and at the end of the third year. Results  EBM knowledge scores increased from baseline by 2.8 points at the end of the second year portion of the course (p = .0001), and by 3.7 points at the end of the third year (p < .0001). Self-rated EBM knowledge increased from baseline by 0.8 and 1.1 points, respectively (p = .0006 and p < .0001, respectively). EBM was felt to be of high importance for medical education and clinical practice at all time points, peaking after the short course. Conclusions  A longitudinal medical school EBM curriculum was associated with increased EBM knowledge. This knowledge increase was sustained throughout the curriculum. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Improving the National Board of Medical Examiners internal Medicine Subject Exam for use in clerkship evaluation

OBJECTIVE: To provide a consensus opinion on modifying the National Board of Medical Examiners (NBME) Medicine Subject Exam (Shelf) to: 1) reflect the internal medicine clerkship curriculum, developed by the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM); 2) emphasize knowledge important for a clerkship student; and 3) obtain feedback about students' performances on the Shelf. DESIGN: Two-round Delphi technique. PARTICIPANTS: The CDIM Research and Evaluation Committee and CDIM members on NBME Step 2 Committees. MEASUREMENTS: Using 1-5 Likert scales (5 = highest ratings), the group rated test question content for relevance to the SGIM-CDIM Curriculum Guide and importance for clerkship students' knowledge. The Shelf content is organized into 4 physician tasks and into 11 sections that are generally organ system based. Each iteration of the Shelf has 100 questions. Participants indicated a desired distribution of questions by physician task and section, topics critical for inclusion on each exam, and new topics to include. They specified the types of feedback clerkship directors desired on students' performances. Following the first round, participants viewed pooled results prior to submitting their second-round responses. RESULTS: Of 15 individuals contacted, 12 (80%) participated in each round. The desired distribution by physician task was: diagnosis (43), treatment (23), mechanism of disease (20), and health maintenance (15). The sections with the most questions requested were the cardiovascular (17), respiratory (15), and gastroenterology (12) sections. The fewest were requested in aging/ethics (4) and neurology, dermatology, and immunology (5 each). Examples of low-rated content were Wilson's Disease, chancroid and tracheal rupture (all <2.0). Health maintenance in type 2 diabetes, hypertension, and cardiovascular disease all received 5.0 ratings. Participants desired feedback by: section (4.6) and physician task (3.9), on performances of the entire class (4.0), and for individual students (3.8). CONCLUSION: Clerkship directors identified test content that was relevant to the curricular content and important for clerkship students to know, and they indicated a desired question distribution. They would most like feedback on their students' performance by organ system-based sections for the complete academic year. This collaborative effort could serve as a model for aligning national exams with course goals.     

Effect of a mandatory geriatric medicine clerkship on third-year students

A nationwide push has increased geriatric medicine instruction within medical school curricula. Some institutions have proceeded with an integrated 4-year curriculum while others have constructed discrete courses in the third or fourth year of medical school. This paper describes the impact of a new mandatory 4-week geriatric medicine clerkship on third-year students developed by the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center. In the first year of implementation, 135 students took the course on both the Oklahoma City and Tulsa campuses. Clinical sites included inpatient, VA extended care unit, outpatient clinics, dementia clinics, home care, long-term care settings, and hospice. Didactic instruction used formal lectures and problem-based learning. The impact of the clerkship on students was assessed in three areas: knowledge, skills, and attitude using a pre- and postknowledge test, student satisfaction survey, and written comments. This article discusses how the clerkship resulted in increased knowledge of geriatric medicine. Student self-report indicates that the clerkship enhanced clinical evaluation and patient assessment skills. Students indicated that the experience was positive and recognized the importance of geriatric medicine in their development as doctors.     

Factors affecting the reliability of ratings of students’ clinical skills in a medicine clerkship

Objective:To determine the overall reliability and factors that might affect the reliability of ratings of students’ clinical skills in a medicine clerkship. Design:A nine-item instrument was used to evaluate students’ clinical skills. Raters were also asked to provide a grade of each student’s overall clinical performance. Generalizability studies were performed to estimate the reliability of the ratings. The effects of rater experience and clerkship setting were investigated by regression analysis. Setting:Teaching hospitals and community-based sites in three Northwestern states. Participants:All students (328) who had completed the 12-week clerkship in internal medicine at one medical school during the academic years 1987–1989. Raters included attending physicians, chief residents, and other residents. Results:Seven observations were needed to provide a reliable rating of the overall clinical grade. More observations were needed to obtain reliable ratings for individual items, ranging from seven observations needed for the rating of data gathering skills to 27 observations needed for the rating of interpersonal relationships with patients. Rater experience and clerkship setting (i.e., teaching hospitals vs. community-based clinics) were found, in general, not to affect significantly the ratings received by students. Conclusions:Reliable ratings of students’ overall clinical skills, including overall clinical grades, can be achieved by collecting a minimum of seven observations. More observations are needed to measure reliably the interpersonal aspects of clinical performance. These findings support the use of performance ratings to evaluate clinical skills and knowledge of students in clerkship settings. Dr. Ramsey is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.     

Factors Associated with Medical Knowledge Acquisition During Internal Medicine Residency

BACKGROUND Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge acquisition. OBJECTIVE To examine associations of learning habits on medical knowledge acquisition. DESIGN, PARTICIPANTS Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the Internal Medicine Residency, Mayo Clinic, Rochester, MN. MEASUREMENTS Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects model. RESULTS When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency, score decrease per year of increasing age, −0.2% (95%CI −0.36%, −0.042%; p = .01), and graduation from a US medical school, score decrease compared to international medical school graduation, −3.4% (95%CI −6.5%, −0.36%; p = .03). CONCLUSIONS Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent associations with knowledge acquisition that were comparable to the benefit of a year in residency training.     

Identifying Medical Students Likely to Exhibit Poor Professionalism and Knowledge During Internship

CONTEXT Identifying medical students who will perform poorly during residency is difficult. OBJECTIVE Determine whether commonly available data predicts low performance ratings during internship by residency program directors. DESIGN Prospective cohort involving medical school data from graduates of the Uniformed Services University (USU), surveys about experiences at USU, and ratings of their performance during internship by their program directors. SETTING Uniformed Services University. PARTICIPANTS One thousand sixty-nine graduates between 1993 and 2002. MAIN OUTCOME MEASURE(S) Residency program directors completed an 18-item survey assessing intern performance. Factor analysis of these items collapsed to 2 domains: knowledge and professionalism. These domains were scored and performance dichotomized at the 10th percentile. RESULTS Many variables showed a univariate relationship with ratings in the bottom 10% of both domains. Multivariable logistic regression modeling revealed that grades earned during the third year predicted low ratings in both knowledge (odds ratio [OR] = 4.9; 95%CI = 2.7–9.2) and professionalism (OR = 7.3; 95%CI = 4.1–13.0). USMLE step 1 scores (OR = 1.03; 95%CI = 1.01–1.05) predicted knowledge but not professionalism. The remaining variables were not independently predictive of performance ratings. The predictive ability for the knowledge and professionalism models was modest (respective area under ROC curves = 0.735 and 0.725). CONCLUSIONS A strong association exists between the third year GPA and internship ratings by program directors in professionalism and knowledge. In combination with third year grades, either the USMLE step 1 or step 2 scores predict poor knowledge ratings. Despite a wealth of available markers and a large data set, predicting poor performance during internship remains difficult. This work was presented at the Mid-Atlantic regional SGIM conference at USU on March 9, 2007. It was also presented at the annual SGIM conference as a Lipkin finalist in Toronto, CA on April 27, 2007. It has been accepted for presentation at the USU Research Week conference May 15, 2007 and has been submitted for presentation at the annual Research in Medical Education conference. This was an unfunded research. The opinions expressed in this paper are those of the authors and should not be construed, in any way, to represent those of the US Army or the Department of Defense.     

Impact of Hurricane Katrina on medical student academic performance: the Tulane experience

BACKGROUND: Hurricane Katrina forced the temporary closure of Tulane University School of Medicine requiring relocation to the Texas Medical Center in Houston, Texas. This required curricular restructuring, and resulted in faculty/student challenges. The effect of these stresses on student performance was studied. METHODS: A pre-Katrina and post-Katrina comparative analysis of all Tulane medical students' performance on standardized exams, internal examination and United States Medical Licensing Examination (USMLE) step exams was performed. A one-way analysis of variance was used to determine if mean examination scores differed from pre-Katrina to post-Katrina. RESULTS: Internal examination scores did not differ significantly. National standardized examination grades significantly decreased pre-Katrina to post-Katrina in Biochemistry, Pharmacology, Pathology, Medicine, Pediatrics and Psychiatry (P < 0.05). There was no statistical change in USMLE scores. CONCLUSIONS: Tulane students had a statistically significant decline in performance on many course and clerkship examinations, though overall performance on licensing examinations was unchanged. Many stresses may have affected students' ability to perform.     

Evaluation of a national curriculum reform effort for the medicine core clerkship

BACKGROUND: In 1995, the Society of General Internal Medicine (SGIM) and the Clerkship Directors in Internal Medicine (CDIM) developed and disseminated a new model curriculum for the medicine core clerkship that was designed to enhance learning of generalist competencies and increase interest in general internal medicine. OBJECTIVE: To evaluate the dissemination and use of the resulting SGIM/CDIM Core Medicine Clerkship Curriculum Guide. DESIGN: Survey of internal medicine clerkship directors at the 125 medical schools in the United States. MEASUREMENTS AND MAIN RESULTS: The questionnaire elicited information about the use and usefulness of the Guide and each of its components, barriers to effective use of the Guide, and outcomes associated with use of the Guide. Responses were received from 95 clerkship directors, representing 88 (70%) of the 125 medical schools. Eighty-seven (92%) of the 95 respondents were familiar with the Guide, and 80 respondents had used it. The 4 components used most frequently were the basic generalist competencies (used by 83% of those familiar with the Guide), learning objectives for these competencies (used by 83%), learning objectives for training problems (used by 70%), and specific training problems (used by 67%); 74% to 85% of those using these components found them moderately or very useful. The most frequently identified barriers to use of the Guide were insufficient faculty time, insufficient number of ambulatory care preceptors and training sites, and need for more faculty development. About 30% or more of those familiar with the Guide reported that use of the Guide was associated with improved ability to meet clerkship accreditation criteria, improved performance of students on the clerkship exam, and increased clerkship time devoted to ambulatory care. CONCLUSION: This federally supported initiative that engaged the collaborative efforts of the SGIM and the CDIM was successful in facilitating significant changes in the medicine core clerkship across the United States. Presented at the Society of General Internal Medicine annual meeting, San Francisco, Calif, April 1999. This work was supported in part by Contract No. 240-930029 from the Bureau of Health Professions, Health Resources and Services Administration.     

Impact of Student Ethnicity and Primary Childhood Language on Communication Skill Assessment in a Clinical Performance Examination

Background Clinical performance examinations (CPX) with standardized patients (SPs) have become a preferred method to assess communication skills in US medical schools. Little is known about how trainees’ backgrounds impact CPX performance. Objective The objective of this paper is to examine the impact of student ethnicity, primary childhood language, and experience of diversity on the communication scores of a high-stakes CPX using SPs. Design This research was designed as an observational study. Participants The participants of this study were third-year medical students at one US medical school. Measurements and Main Results The measurements used in this study were CPX scores from mandatory exam, student demographics and experience with diversity measured by self-report on a survey, and Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) scores. A total of 135 students participated. Asian and black students scored lower than white students on the communication portion of the CPX by approximately half a standard deviation (Asian, 67.4%; black, 64.4%; white, 69.4%, p < .05). There were no differences by ethnicity on history/physical exam scores. Multivariate analysis controlling for MCAT verbal scores reduced ethnic differences in communication scores (Asian–white mean differences = 1.95, p = 0.02), but Asian–white differences were eliminated only after sequential models included primary childhood language (difference = 0.57, p = 0.6). Conclusions Even after controlling for English language knowledge as measured in MCAT verbal scores, speaking a primary childhood language other than English is associated with lower CPX communication scores for Asian students. While poorer communication skills cannot be ruled out, SP exams may contain measurement bias associated with differences in childhood language or culture. Caution is indicated when interpreting CPX communication scores among diverse examinees. Presented at SGIM National Meeting April 2006     

Innovative Health Care Disparities Curriculum for Incoming Medical Students

Purpose  1) To pilot a health disparities curriculum for incoming first year medical students and evaluate changes in knowledge. 2) To help students become aware of personal biases regarding racial and ethnic minorities. 3) To inspire students to commit to serving indigent populations. Methods  First year students participated in a 5-day elective course held before orientation week. The course used the curricular goals that had been developed by the Society of General Internal Medicine Health Disparities Task Force. Thirty-two faculty members from multiple institutions and different disciplinary backgrounds taught the course. Teaching modalities included didactic lectures, small group discussions, off-site expeditions to local free clinics, community hospitals and clinics, and student-led poster session workshops. The course was evaluated by pre-post surveys. Results  Sixty-four students (60% of matriculating class) participated. Survey response rates were 97–100%. Students’ factual knowledge (76 to 89%, p < .0009) about health disparities and abilities to address disparities issues improved after the course. This curriculum received the highest rating of any course at the medical school (overall mean 4.9, 1 = poor, 5 = excellent). Conclusions  This innovative course provided students an opportunity for learning and exploration of a comprehensive curriculum on health disparities at a critical formative time.