Does Clerkship Rotation Sequence Affect Performance on National Board of Medical Examiners (NBME) Clinical Subject Examinations and United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) Examination?

Purpose: To investigate whether starting the clerkship year in family medicine (FM), internal medicine (IM), pediatrics, or surgery influences NBME shelf and USMLE Step 2 CK examination performance. Methods: USMLE Step 1, Step 2 CK, and shelf examination scores for FM, IM, pediatrics, and surgery were collected. Sequences were selected on the following assignment criteria: rotation 1 (either FM or IM), rotation 5 (pediatrics), rotation 8 (surgery), rotation 1 (either pediatrics or surgery), and rotation 8 (IM). Multivariate analysis of covariance, with Step 1 as the covariate, was used to investigate rotation sequence on examination performance. Results: Wilks’s statistic found no statistically significant effect of rotation sequence (starting the clerkship year in FM or IM) on the pediatrics, surgery, and Step 2 CK examinations (Λ =.95, F[3,51] =.93, p ≤.432). Wilk’s statistic for the covariate (Step 1) was statistically significant (Λ =.488, F[3,51] = 17.827, p ≤.001), indicating the two groups differ on Step 1 performance. Wilk’s statistic found no statistically significant effect of rotation sequence (starting the clerkship year in pediatrics or surgery) on the IM and Step 2 CK results (Λ =.925, F[2,75] = 3.036, p ≤.054). Wilk’s statistic for the covariate (Step 1) was statistically significant (Λ =.309, F[2,75] = 83.915, p ≤.001) indicating that the two groups differ on Step 1 performance. Conclusion: Starting the clerkship year in FM, IM, pediatrics, or surgery does not influence subsequent performance on shelf examinations or on Step 2 CK.