Referral for competency committee review for poor performance on the internal medicine clerkship is associated with poor performance in internship.

Purpose: To determine how students who are referred to a competency committee for concern over performance, and ultimately judged not to require remediation, perform during internship.

Methods: Uniformed Services University of the Health Sciences' students who graduated between 2007 and 2011 were included in this study. We compared the performance during internship of three groups: students who were referred to the internal medicine competency committee for review who met passing criterion, students who were reviewed by the internal medicine competency committee who were determined not to have passed the clerkship and were prescribed remediation, and students who were never reviewed by this competency committee. Program Director survey results and United States Medical Licensing Examination (USMLE) Step 3 examination results were used as the outcomes of interest.

Results: The overall survey response rate for this 5-year cohort was 81% (689/853). 102 students were referred to this competency committee for review. 63/102 students were reviewed by this competency committee, given passing grades in the internal medicine clerkship, and were not required to do additional remediation. 39/102 students were given less than passing grades by this competency committee and required to perform additional clinical work in the department of medicine to remediate their performance. 751 students were never presented to this competency committee. Compared to students who were never presented for review, the group of reviewed students who did not require remediation was 5.6 times more likely to receive low internship survey ratings in the realm of professionalism, 8.6 times more likely to receive low ratings in the domain of medical expertise, and had a higher rate of USMLE Step 3 failure (9.4% vs. 2.8%). When comparing the reviewed group to students who were reviewed and also required remediation, the only significant difference between groups regarding professionalism ratings with 50% of the group requiring remediation garnering low ratings compared to 18% of the reviewed group.

Conclusions: Students who are referred to a committee for review following completion of their internal medicine clerkship are more likely to receive poor ratings in internship and fail USMLE Step 3 compared to students whose performance in the medicine clerkship does not trigger a committee review. These findings provide validity evidence for our competency committee review in that the students identified as requiring further clinical work had significantly higher rates of poor ratings in professionalism than students who were reviewed by the competency committee but not required to remediate. Additionally, students reviewed but not required to remediate were nonetheless at risk of low internship ratings, suggesting that these students might need some intervention prior to graduation.