Standardized patient assessment of ambulatory clerks: Effect of timing andorder of the clerkship

Background: A standardized patient examination may assess unique learning i n an ambulatory clerkship but, as with written tests, may be affected by st udent maturation. Purpose: To explore the effect of timing and order of a medicine ambulatory clerkship on student performance of a standardized patient examination (SP E). Methods: All students rotating through an ambulatory medicine clerkship in 1 academic year completed an SPE designed to reflect specific learning obje ctives of the clerkship as well as nonclerkship case content. Students were grouped according to prior inpatient clerkship experience. Results: When compared to students with only ambulatory experience students with both inpatient and ambulatory experiences in internal medicine did no t perform better on the ambulatory cases of the SPE but did perform better on nonclerkship cases. Performance on the SPE was not affected by month of training. At completion of the inpatient clerkship, students with prior amb ulatory experience did not perform better than students with inpatient-only experience on the National Board of Medical Examiners Medicine Subject Exa mination. Conclusions: The SPE is an appropriate assessment tool for the ambulatory c lerkship when case content is linked to learning objectives of the clerkshi p. Unlike other knowledge-based assessments, the SPE is not affected by stu dent maturation.