Impact of a 2-week flipped classroom virtual neurology clerkship versus a traditional 4-week rotation on NBME shelf exam scores.

Objective: There is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship.

Background: There is conflicting evidence whether decreased clerkship duration is associated with reduced NBME shelf examination performance. We hypothesized that Neurology shelf exam scores would remain stable for students in a shortened 2-week flipped classroom-based virtual rotation as compared to the traditional 4-week Neurology clerkship with direct patient care supplemented by didactics.

Methods: This is a retrospective observational cohort study. In April 2020, the neurology clerkship at Rutgers Robert Wood Johnson Medical School switched from a traditional 4-week in-person clinical rotation supplemented by didactics to a 2-week flipped classroom-based virtual-only curriculum decoupled from a supplementary 2-week in-person clinical rotation to be completed later. Students were offered the opportunity to test after the 2-week virtual curriculum. NBME shelf scores for these "exam before clinical rotation" (EBC) students over the final quarter of the academic year 2019-2020 were compared to those of the "exam after clinical" (EAC) students undergoing the 4-week traditional rotation from July 2018 to March 2020.

Results: 321 students completed the shelf exam between July 2018 and June 2020, of which 284 students comprised the EAC cohort and 37 students, the EBC cohort. Mean scores did not differ between the EBC and EAC cohorts (81.8 ± 6.7 versus 81.8 ± 6.5, p = 0.96). Additional analyses showed no significant differences in the performance of EBC students as compared to the EAC students that tested within the same academic year 2019-2020 or within the matched quarter of the prior academic year 2018-2019, and students completing the virtual rotation who delayed testing after the clinical experience.

Conclusions: Testing after a 2-week flipped classroom-based virtual curriculum in Neurology without additional clinical training did not negatively affect neurology NBME shelf scores. Decoupling clinical experiences from knowledge acquisition and the evaluation of that knowledge base by means of NBME shelf examination is not likely to disadvantage learners with respect to shelf examination performance.