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Background: The logistical necessity of students taking required clinical clerkship rotations in non-uniform sequences may have significant consequences on performance. Aims: To investigate (1) the impact of previous clinical clerkship experience and the national licensing examination (USMLE Step 1) rankings on end-of-clerkship overall skills assessments and (2) the effect of clinical clerkship order on end-of-year objective structured clinical examination (OSCE) performance. Method: The core clinical phase of UCLA consists at six clinical clerkships during a 48-week continuum. The clerkships are structured in two different tracks with different rotation order. Clinical performance scores were analyzed for 124 year-3 students in the two different tracks. Results: Performance, as reviewed on a standardized clinical clerkship evaluation form by faculty and residents, improved significantly across the clinical year, regardless of track suggesting an accumulated advantage of previous experiences. There were no significant differences between tracks on the OSCE. Conclusions: Overall clinical skills are more directly impacted by the time-of-year and not order whereas knowledge of specific specialties may be impacted by the order rotations that are taken. While this may not be obvious to students, perhaps we should share these results for their use in tracking their personal growth in clinical skills. [ABSTRACT FROM AUTHOR]

OBJECTIVES This study examined the construct validity of three commonly used clerkship performance assessments, including preceptors' evaluations, objective structured clinical examination (OSCE)-type clinical performance measures, and the National Board of Medical Examiners (NBME) medicine subject examination, in order to better understand their conceptual structures and utility in the explanation of clinical competence. METHODS A total of 686 students who took an in-patient medicine clerkship during the period 2003 to 2007 participated in the study. Exploratory and confirmatory factor analyses using structural equation modelling were adopted to examine the latent domains underlying various indicators assessed by these three measures and the pattern of indicator-domain relationships. RESULTS Factor analyses found three latent constructs, labelled Clinical Performance, Interpersonal Skills and Clinical Knowledge, underlying the observed measures. The three domains were modestly correlated with one another (inter-factor correlation coefficients ranged from 0.39 to 0.54). They also tapped a common higher-order construct, Clinical Competence, in varying degrees of magnitude (0.73, 0.74, 0.53, respectively). CONCLUSIONS The study demonstrated that although the three commonly used tools for assessing clerkship performance contributed uniquely to the understanding of clinical performance, they also attested to a shared domain of clinical competence in their assessment. The study confirmed the need for a multiple-methods approach to clinical performance assessment. Findings also revealed that clerkship preceptors need to differentiate their evaluation of students' performances, and that the OSCE did not assess a single domain of clinical competence. [ABSTRACT FROM AUTHOR]