Effect of clinical teaching on student performance during a medicine clerkship

PURPOSE: To measure what proportion of student clerkship performance can be attributed to teachers’ educational skills as reported by students. SUBJECTS AND METHODS: From August 1992 to June 1994, we collected critiques of teacher skills from 314 third-year students at the end of a 12-week medicine clerkship. Interns, residents, attending physicians, and student preceptors were rated (on a 1 to 5 scale) on teaching behaviors from the 7 categories of the Stanford Faculty Development Program framework. A linear regression model was used to determine the relative contributions of the rated teaching behaviors in predicting final student performance and improvement across the clerkship (“student growth”), measured using end-of-clerkship variables (clinical grades, National Board of Medical Examiners medicine shelf examination, practical laboratory examination, and an analytical essay examination) and preclerkship variables (pre–third-year grade point average [GPA], United States Medical Licensing Examination, Step I, and clerkship pretest). RESULTS: Data were available for 293 (93%) of 314 students, who completed a total of 2,817 critiques. The students’ preclerkship GPA accounted for the greatest percentage of variance in student performance (28%, P<0.0001). Clinical teaching behaviors accounted for an additional 6% (P<0.0001) of the variance. For student growth across the clerkship, teaching accounted for 10% of the variance (P<0.0001). Among the 7 Stanford educational categories, teaching behaviors promoting control of session (r2 = 5%, P = 0.0002) and fostering understanding and retention (r2 = 4%, P = 0.001) had the greatest effect. The resident had the most effect on student growth (r2 = 6%, P = 0.0001) when compared with other teaching levels. Teaching had a greater effect on growth for students with preclerkship GPA above the mean (16% versus 6%), for older students (24% versus 7%), and for students with a nonscience undergraduate degree (33% versus 9%). CONCLUSION: The preclerkship GPA, reflecting 2 years of work, was the most important predictor of student performance. Teaching behavior, as measured by student assessments, also affected student performance.