A DROP IN PEDIATRIC SUBJECT EXAMINATION SCORES AFTER CURRICULUM CHANGES THAT EMPHASIZE GENERAL PEDIATRIC TOPICS

Objective: To determine whether emphasizing a limited number of genera l pediatric objectives and using a test based on them would improve st udent knowledge of the topic areas. Design: Before-after trial. Settin g: Community-based medical school. Subjects: Third-year medical studen ts on a required clerkship in pediatrics. Intervention: Six core objec tives: recognizing the seriously ill child, stabilizing such a child, fluid and electrolyte requirements and therapy, newborn care, well chi ld care, and variability of normal vital signs in children based on th eir age were defined and a modified essay examination was constructed. The test was given to pediatric students close to the end of their cl erkship. In study year 1, no warning was given about the examination a nd results did not affect student grades. In study year 2, passing all items was a requirement and failure required remedial oral examinatio n of any missed items. All students completed the National Board of Me dical Examiners pediatric subject examination. Results: For 7 of 8 ess ay items, significant increases in numbers of students passing were se en in study year 2, but students scored 51 paints lower on the Nationa l Board of Medical Examiners pediatric subject examination (P = .002). The decrease in scores was not seen in any other clerkship or among p ediatric students from a different campus of the medical school. Concl usions: Emphasis on core objectives and an essay examination significa ntly improved students' knowledge of the defined topics but decreased the scores on the National Board of Medical Examiners subject examinat ion. This may be attributable to a difference in content between the 2 tests. Faculty proposing new curriculum guidelines need to review stu dent assessment methods to avoid such unexpected changes in scores.