Effect of Curriculum Changes on Student Performance During General Surgical Clerkship.

INTRODUCTION: Good clinical knowledge of anatomy, taught in medical school, is necessary for practicing physicians. It is a key feature of performance on the United States Medical Licensing Examination Step 1 score. Student performance on anatomy is also an early indicator of overall medical student performance. Unfortunately, curricular time provided for the teaching of anatomy has declined significantly over the last 30 years, leading to growing concerns that the anatomical knowledge of new medical graduates may not be adequate. Data regarding the impact of these changes to the medical school curriculum are lacking, with studies often being limited in number of medical students or time. METHODS: This study examined the anatomy knowledge of students on third-year clinical rotations at Tulane University Medical School. Oral examinations were administered at the conclusion of the junior surgical clerkship. Data on performance were collected over a 5-year period from 690 medical students tested in their knowledge of anatomy, and the other basic sciences collectively considered as pathophysiology. RESULTS: Over the 5-year period, student total scores by year increased in all categories tested. However, during the course of the students' third-year clerkships, the later in the year the students rotated on surgery, the more their scores progressively declined. Unfortunately, this fall was most severe in the knowledge of anatomy. DISCUSSION: Although it is possible to teach anatomy in increasingly shorter periods of time, such that the students achieve high test scores in the standardized short answer examinations, it is clear that their knowledge, as applied to clinical care, rapidly declines the further they get away from Step 1 studying. Further study is necessary to elucidate the weaknesses in the current basic science curricula as they pertain to anatomy and to devise mechanisms to assure retention of this critical science during clinical rotations and beyond into practice.