The impact of a curriculum renewal project on students' performances on a fourth-year clinical skills assessment.

Purpose: To study the performances of three consecutive classes of medical students on a fourth-year clinical skills assessment that remained constant during a curriculum renewal project that involved earlier clinical work, more ambulatory training, and an emphasis on lifelong learning.

Method: Three classes were involved: 83 baseline students (class of 1997) educated in the old curriculum, 77 transitional students (class of 1998) exposed to some curricular change, and 88 renewal students (class of 1999) in the first year of full curricular change. Each class completed a fourth-year assessment, during which students performed a focused history and physical examination on 14 standardized patients. Scores for these elements were calculated as the percentages of items obtained. Each case also includes a communication skills element rated on the Arizona Clinical Interview Rating scale (ACIR).

Results: Small but significant improvements in the means of scores were found in all three elements of the assessment over the study period (history taking scores increased from 74% to 80%, physical exam scores increased from 51% to 58%, and ACIR scores increased from 3.7 to 4.0). More pronounced was the decline in the percentage of students who failed the assessment (from 8% to 0%), and a marked increase in those who passed over 80% of the case elements (from 65% to 89%).

Conclusion: Renewing the curriculum to expose students to clinical skills earlier, increase the amount of ambulatory training, and promote lifelong learning resulted in small but significant increases in students' performances on a fourth-year clinical skills assessment. The major impact of the new curriculum, however, was to improve the clinical skills assessment performances of marginal and average students.