A drop in pediatric subject examination scores after curriculum changes that emphasize general pediatric topics
M. J. Potts and K. W. Phelan
Department of Pediatrics, University of Illinois, College of Medicine at Rockford, 61104, USA. michaelp@uic.edu
OBJECTIVE: To determine whether emphasizing a limited number of general
pediatric objectives and using a test based on them would improve student
knowledge of the topic areas. DESIGN: Before-after trial. SETTING:
Community-based medical school. SUBJECTS: Third-year medical students on a
required clerkship in pediatrics. INTERVENTION: Six core objectives:
recognizing the seriously ill child, stabilizing such a child, fluid and
electrolyte requirements and therapy, newborn care, well child care, and
variability of normal vital signs in children based on their age were
defined and a modified essay examination was constructed. The test was
given to pediatric students close to the end of their clerkship. In study
year 1, no warning was given about the examination and results did not
affect student grades. In study year 2, passing all items was a requirement
and failure required remedial oral examination of any missed items. All
students completed the National Board of Medical Examiners pediatric
subject examination. RESULTS: For 7 of 8 essay items, significant increases
in numbers of students passing were seen in study year 2, but students
scored 51 points lower on the National Board of Medical Examiners pediatric
subject examination (P=.002). The decrease in scores was not seen in any
other clerkship or among pediatric students from a different campus of the
medical school. CONCLUSIONS: Emphasis on core objectives and an essay
examination significantly improved students' knowledge of the defined
topics but decreased the scores on the National Board of Medical Examiners
subject examination. This may be attributable to a difference in content
between the 2 tests. Faculty proposing new curriculum guidelines need to
review student assessment methods to avoid such unexpected changes in
scores.
