Clerkship curricular revision based on the Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics guidelines: does it make a difference?

OBJECTIVE To compare general pediatric knowledge acquisition and clinical problem-solving skills by students pre- and postcurricular reform based on the 1994 Ambulatory Pediatric Association and the Council on Medical Student Education in Pediatrics (APA-COMSEP) curricular guidelines. SETTING A large, urban academic medical center. SUBJECTS Third-year medical students on a required clerkship in Pediatrics. INTERVENTION Pre- and postcurricular revision, the students were given both the National Board of Medical Examiners (NBME) Pediatric Subject Examination and an objective examination, which was developed in-house, based on the APA-COMSEP guidelines (Pediatric Clerkship Examination [PCE]). Baseline data before curricular revision were obtained on 52 students from May 1995 to May 1996. After curricular redesign in May 1996, data were obtained on 42 students from May 1996 to May 1997. Curricular revision focused on the following: defining educational principles, selecting teaching strategies, defining learning objectives, implementing the curriculum, and evaluating the students with an examination. RESULTS Before curricular revision, the average NBME score was 521 +/- 122. The average PCE score was 53.7% +/- 10.1%. After curricular revision, the average NBME score was 520 +/- 109, and the average PCE score was 67.7% +/- 8.4%. Content areas showing the greatest improvement were fluids and electrolytes, issues pertaining to the newborn, and health supervision. CONCLUSIONS Our baseline data indicate that despite spending two thirds of the clerkship in the ambulatory setting, students did not acquire adequate general pediatric knowledge or clinical problem-solving ability. After broad clerkship revision based on the APA-COMSEP Core Curriculum, students' acquisition of general pediatric knowledge and clinical problem-solving improved significantly, as measured by the PCE. The overall NBME Pediatric Subject Examination scores did not reflect this increased acquisition of general pediatric knowledge.