Optimizing Clinical Assessment for Medical Students: A Longitudinal Interleaved Clerkship Model with Condensed Clinical Shelf Exam Testing

Abstract Background: The transition of the United States Medical Licensing Examination (USMLE) Step 1 to a pass/fail scoring system is reshaping its role in predicting medical students' residency placements. This shift compels medical institutions to rethink their clerkship and Step 2 preparation strategies, raising concerns about its impact on underrepresented and disadvantaged students who already grapple with barriers in medical school admissions, contributing to disparities. Traditionally, medical schools followed the Traditional Block Rotation model for clerkships, which lacked continuity and depth in patient-physician interactions. In response, these models are being replaced by Longitudinal Integrated Clerkships and Longitudinal Interleaved Clerkships (LInC) to enhance student’s clerkship learning. The growth in longitudinal popularity sparks concern for the success of various demographics as there is minimal research regarding LInC students' USMLE performance. Our study aims to uncover if LInCs provide equitable medical education for underrepresented and disadvantaged groups in medicine. Method: Utilizing institutional data from Kirk Kerkorian School of Medicine (KSOM), this study evaluated student’s Step 1 and Step 2 scores as well as their self-identified demographic information prior to the change in Step 1 grading. The analysis involved 145 students from three KSOM cohorts, categorized by admissions and initial performance factors. Binary groups were created for each variable. Descriptive statistics and t-tests (including Levene's Test) gauged score change significance (p < 0.05) within these groups. Changes were assessed by subtracting Step 1 from Step 2 scores, identifying groups showing substantial score improvements after completing the LInC clerkship and testing model. Results: Analysis revealed significant score improvements between Step 1 and Step 2 for the following groups: females, students with low socioeconomic status, and students who originally received lower Step 1 scores. Conclusion: This study underscores the significance of gender, socioeconomic status, and prior exam performance in clerkship models. Further research is needed to discern whether the observed score changes are attributed to the LInC model or the school's testing methods, with potential far-reaching implications for medical school curricular adjustments amidst the transition to pass/fail scoring for Step 1, as students prepare for Step 2 and residency applications.