The emphasis on a generalist professional education has led to shortening a
nd restructuring of the surgery clerkship in the curricula of many medical
schools. Little data exist regarding the effect of these changes on student
performance. Therefore, we examined the effect of the length, timing, and
content of the third year surgery rotation on several clerkship and post-cl
erkship performance measures of 487 students from July 1994 to July 1998. I
n addition, students' perceptions regarding their ability to understand sur
gical disease topics were surveyed. The 8-week clerkship (n = 232) was asso
ciated with higher NMBE surgery test scores (510.5 +/- 6.3 versus 457.4 +/-
10.0, P < 0.05) resulting in higher final clerkship grades (5.15 +/- 0.04
versus 4.87 +/- 0.03, P < 0.05). Although clerkship length had no significa
nt effect on USMLE step 2 total or surgery subsection scores, the longer cl
erkship was associated with higher total (70.6 +/- 0.37 versus 68.8 +/- 0.5
0, P < 0.05) and abdominal pain station (81.87 +/- 0.71 versus 79.54 +/- 0.
73, P < 0.05) OCSE scores; Students rotating on surgery during the second h
alf of third year (n = 233) had higher NMBE surgery test scores (513.1 +/-
8.9 versus 460.5 +/- 11.2, P < 0.05) and final grades (5.17 +/- 0.03 versus
4.81 +/- 0.04,P < 0.05). Although the timing of the surgery clerkship did
not significantly affect total OSCE scores, students who rotated on surgery
in the second half of third year performed significantly better year on th
e abdominal pain OSCE station (80.47 +/- 0.92 versus 76.49 +/- 1.27, P < 0.
05). Students who rotated on general surgery (n = 298) performed significan
tly better on the NBME surgery test (525.6 +/- 6.0 versus 459.6 +/- 9.1, P
< 0.05), although this did not significantly affect the final grade. Althou
gh general versus subspecialty surgery rotation did not significantly affec
t total OSCE scores, students rotating on general surgery performed signifi
cantly better on the abdominal pain OSCE station (81.21 +/- 0.91 versus 78.
17 +/- 0.32, P < 0.05). The length, timing, and content of the third year s
urgery relation had no significant effect on performance on the oral examin
ation. Students who had a 6-week clerkship and students who lacked exposure
to general surgery felt their surgery rotation failed to prepare them to u
nderstand a number of surgical topics as well as students who had an El-wee
k clerkship or students who rotated on general surgery. The length, timing,
and content of the surgery clerkship affect some clerkship performance mea
sures and student perceptions of their understanding of surgical disease to
pics. While cognitive differences related to clerkship length are no longer
detectable at the end of the third year of medical school, differences rel
ated to the acquisition of some clinical skills persist after the surgery c
lerkship, (C) 1999 Academic Press.