The effect of a clinical problem-solving curriculum on medical student examination performance

The objective of this study was to determine whether a clinical problem-solving curriculum during the third-year obstetrics/gynecology clerkship would affect National Board Medical Examiners (NBME) subject test performance. During the 1999-2000 academic year, 184 third-year medical students rotated through the obstetrics/gynecology clerkship. They were assigned to one of three clinical training sites. Thirty-six students were assigned to a community hospital, whereas the remaining 148 students were assigned to either a private university hospital or a county hospital. In July 1, 1999, the community hospital adopted a problem-solving curriculum designed to stimulate a better understanding of underlying mechanisms of disease rather than the memorization of facts. Each morning, an attending physician spent 20 minutes on interactive conferences. At the end of the clerkship, each student took the NBME subject test for obstetrics and gynecology. A test score of 80 was chosen as the honors level. Students who participated in the problem-solving curriculum scored significantly higher than did those taught by the traditional program, based on median NBME subject test scores, 79.0 (interquartile range, 74.0-82.0) versus 71.0 (interquartile range, 65.0-76.5), P < .001, and the proportion with subject scores ≥80, (44.4% versus 10.1%, P < .001). A clinical problem-solving curriculum may lead to higher NBME test scores.