Effect of clinical teaching on student performance during a medicine clerkship

PURPOSE: To measure what proportion of student clerkship performance can be attributed to teachers' educational skills as reported by students. SUBJECTS AND METHODS: From August 1992 to June 1994, we collected critiques of teacher skills from 314 third-year students at the end of a 12-week med icine clerkship. Interns, residents, attending physicians, and student prec eptors were rated ton a 1 to 5 scale) on teaching behaviors from the 7 cate gories of the Stanford Faculty Development Program framework. A linear regr ession model was used to determine the relative contributions of the rated teaching behaviors in predicting final student performance and improvement across the clerkship ("student growth"), measured using end-of-clerkship va riables (clinical grades, National Board of Medical Examiners medicine shel f examination, practical laboratory examination, and an analytical essay ex amination) and preclerkship variables (I)rc-third-year grade point average [GPA], United States Medical Licensing Examination, Step 1, and clerkship p retest). RESULTS: Data were available for 293 (93%) of 314 students, who completed a total of 2,817 critiques. The students' pre clerkship GPA accounted for th e greatest percentage of variance in student performance (28%, P <0.0001). Clinical teaching behaviors accounted for an additional 6% (P <0.0001) of t he variance. For student growth across the clerkship, teaching accounted fo r 10% of the variance (P <0.0001). Among the 7 Stanford educational categor ies, teaching behaviors promoting control of session (r(2) = 5%, P = 0.0002 ) and fostering understanding and retention (r(2) = 4%, P = 0.001) had the greatest effect. The resident had the most effect on student growth (r(2) = 6%, P = 0.0001) when compared with other teaching levels. Teaching had a g reater effect on growth for students with preclerkship GPA above the mean ( 16% versus 6%), for older students (24% versus 7%), and for students with a nonscience undergraduate degree (33% versus 9%). CONCLUSION: The preclerkship GPA, reflecting 2 pears of work, was the most important predictor of student performance. Teaching behavior, as measured by student assessments, also affected student performance. (C)2001 by Excer pta Medica, Inc.