COMPARING PERFORMANCE OF THIRD-YEAR MEDICAL STUDENTS PRE- AND POST-PANDEMIC
same time, there was no statistically significant difference ni their final grades (Table 1). Figure 1 shows the box-plot diagram summarizing the results. The quiz and NBME scores showed a weak positive correlation in both groups (Figure 2). DISCUSSION: Our finding was contrary to previous reports. Anderson et al.4 reported a 22.4% reduction in NBME shelf exam performance for the COVID-19 pandemic cohort. Hanson et al. ( 7 ) noticed that students who completed their core pediatric clerkship during the COVID-19 pandemic were significantly more likely to fail their end-of-clerkship NBME shelf exam. They attributed the increased failure rates to issues with acquiring and retaining pediatric medical knowledge. In another study, Aaraj et al. ( 8 ) noted no effect of the COVID-19 pandemic on the end-of-clerkship scores. One of the reasons for better performance on quizzes and NBME shelf exams could be the availability of more time for self-study. During the true pandemic, students saved traveling time as they mostly practiced remote learning. The other reason could be explained by the e-learning format. Experience reported in pre-clinical clerkships has shown that students who engaged with electronic books (eBooks) performed significantly better in objective assessments ( 9 ) . In another study, Faner et al. ( 10 ) reported no significant difference in scores among pre-clinical students using video calls ( zoom) and on-campus teaching. In a recent study, Guluma and Brandl ( 11 ) described that transitioning to virtual learning allowed students to adapt their own study strategies, and they were able to reduce group study time and increase self-study time. Our findings suggested that the student’s performance in the standardized examination at our academic institution was improved during the COVID-19 pandemic favoring remote learning. Educators have used the flip ped -classroom (FC) model as an alternative to in-person learning ( 12 ) . FC model consists of teaching modules, where students receive lectures in the format of PowerPoint slides format or recorded lectures. After reviewing the assignment, students meet with faculty to discuss the topic and interact with questions and answers flip ped instead of faculty giving the lecture in the hall and students reviewing the topic remotely and then engaging in active learning on-site- the lecture hall or class. Xiong et al. 12 agreed that in addition to engaging students in active learning, no clinical core rotation should be designed to be completely virtual. The acquisition of clinical skills involves hands-on experience. In our program, the subjective score consists of 65% of the final grades. As these scores included the evaluation provided by the supervising faculty and residents, these could be used as a surrogate of students’ engagement during rotations in the wards, clinics, and newborn nursery. Quizzes and NBME shelf exams evaluate students’ medical knowledge, not clinical skills. The final grade, on the other hand, assesses the medical students’ performance more comprehensively as we evaluate their communication skills, patient care and bedside manners, medical knowledge,
grade records of medical students’ evaluations were accessed to obtain the exam scores.
The pediatric clerkship is a 6-week rotation. Third-year medical students rotate through inpatient and outpatient services to get a global view of children’s healthcare. During the rotation, they are taught by faculty attendings using didactic lectures and bedside teaching. Performance was assessed by the total scores and grades. We compared the two groups’ quiz scores, National Board of Medical Examiners (NBME) scores, and clerkship final grade scores. The NBME Clinical Science Pediatric Shelf exam ( 6 ) , which assesses third-year medical students’ ability to treat children and adolescents, was administered on the last day of the sixth week. The NBME score constitutes 30% of the total score. The quiz consists of 50 multiple-choice questions with a one- best-answer format, extracted from an intradepartmental pool of clinical vignettes, which students took online, being proctored by the clerkship coordinator. There is no cutoff grade for passing/ failing, but students understand that the quiz score represents 5% of their final grades for the clerkship. The subjective score constitutes 65% of the total score. The final grade of the clerkship comprised a cumulative 360-degree evaluation score, including objective evaluations like the quiz and NBME shelf exam, and a subjective component which included assessments of their clinical performance and evaluation scores from residents and attendings during the rotation through wards, clinics, and nursery. Group A comprised the medical students from graduating class of 2022 who took pediatrics during the acceleration phase of the pandemic (true pandemic phase). Group B included the class of 2023, which took pediatrics during the deceleration phase (control phase). The data was collected from July 1st -June 30th of their third academic year cycle (The data collection year was a year prior to the graduating year- the class was identified as the year of graduation). The Pediatric clerkship is a 6-week rotation. Annually, there are eight blocks of a 6-weeks rotation. The total number of students reflects the annual numbers. The number of students varies during each block (ranging from 14-22). We did not look at the names or individual scores to comply with the student’s privacy. The mean cumulative score for the whole class was compared between the groups. We used the Microsoft excel program for data analysis and conventional statistics. We use a two-tailed test student (t-test) for comparative analysis. RESULTS: The true pandemic group comprised 134 students, while the control group had 147 students. The average overall final grade was greater than 90, which is cataloged as an honor grade in our institution. We noted a statistically significant difference in the quiz and NBME scores between the true pandemic phase and control phase groups, 74.97 + 8.11 vs. 70.00 + 8.60, p =< 0.001, 80.35 + 7.09 vs. 78.58 + 7.10, p = 0.03, respectively. At the
Shabih Manzar, MD, MPH 1 Patricia Pichilingue-Reto, MD 2 1 Director, Pediatric Clerkship 2 Co-director, Pediatric Clerkship Department of Pediatrics
Correspondence to: Shabih Manzar, MD, MPH Louisiana State University Health Sciences Center at Shreveport 1501 Kings Hwy, Shreveport, LA, 71103 Phone: 318-675-7275 Fax: 318-675-6059 Email: shabih.manzar@lsuhs.edu
Louisiana State University Health Sciences Center, Shreveport, LA Ochsner LSU Health, St. Mary Medical Center, Shreveport, LA
KEYWORDS: COVID-19, Performance, Medical Students FUNDING AND FINANCIAL SUPPORT: None
the control group had 147 students. We noted a statistically significant difference in the quiz and NBME scores between the true pandemic phase and control phase groups. The mean quiz score of group A was 74.97 + 8.11 versus group B of 70.00 + 8.60, p = < 0.001. The mean NBME score of group A was 80.35 + 7.09 versus group B of 78.58 + 7.10, p = 0.03. The mean final grade scores between groups A and B were not statistically significant, 90.46 + 3.01 and 90.64 + 2.49, p = 0.58. Conclusions: We noted improved performance, assessed by examination scores, among students during the pandemic phase. Further studies would be needed to look at the effect of virtual learning on skill acquisition and clinical performance. pandemic medical education ( 1 ) . Questionnaire-based studies have shown that medical students were more motivated during the pandemic ( 2 ) and learned equally with the virtual learning process ( 3 ) . These studies looked at motivation and learning as qualitative data. On the quantitative side, earlier studies have demonstrated the impact of COVID-19 on academic INTRODUCTION: The COVID-19 has impacted performance and personal experience among pre-clerkship medical students 4,5. Anderson et al. ( 4 ) noted that during the COVID-19 pandemic, preclinical first-semester students did not score above the national average as much as first- semester students pre-COVID -19 . Chang et al. ( 5 ) observed that the NBME scores of the intra-pandemic preclinical class were significantly higher than the pre-pandemic class. We planned this study to compare the performance of medical students during their pediatric clinical clerkship pre- and post-pandemic. METHODS: The study protocol was presented to the institutional review board (IRB). The IRB determined that the proposed activity is not research involving human subjects as defined by the Department of Health and Human Services and Food and Drug Administration regulations. For this study, the examination performance and
CONFLICT OF INTEREST: None
ACKNOWLEDGMENT: Authors would like to thank Ms. Shirley Turner for providing the data. DISCLOSURE: The result of this study is published as a comment in Medical Teacher. Manzar S. Study adaptation and NBME scores [published online ahead of print, 2023 Feb 25]. Med Teach . 2023;1. doi:10.1080/0142 159X.2023.2182661
ABSTRACT: Background:
The COVID-19 pandemic has impacted medical education. We planned this study to look at the performance of medical students pre- and post-pandemic during their pediatric clinical clerkship. Methods: We compared the quiz, National Board of Medical Examiners (NBME), and clerkship final grade scores of the two groups. Group A comprised the medical students from graduating class of 2022 who took pediatrics during the acceleration phase of the pandemic (true pandemic phase). Group B included the class of 2023, which took pediatrics during the deceleration phase.
Results: The true pandemic group comprised 134 students, while
24 J LA MED SOC | VOL 175 | SUMMER 2023
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