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Objective <p>The length of internal medicine (IM) clerkships has decreased over time, with unclear impact on clinical performance metrics. The ORIME (Observer-Reporter-Interpreter-Manager-Educator) framework was used to assess the impact of different IM clerkship lengths and how completion of prior clerkships affected students’ IM clinical performance.</p> Design <p>Between 1/25/21 and 3/22/24, physician evaluators rated clerkship students’ clinical performance using the ORIME scale (Scale: 1 = Observer/Pre-Reporter; 2 = Reporter; 3 = Interpreter; 4 = Manager). Comparisons were made between final ORIME scores for students in four- and eight-week versions of the clerkship, as well as for cumulative clinical exposure time across IM-aligned specialties and all specialties.</p> Participants <p>Of the 179 third-year medical students participating in the study, 119 (66.5%) completed the 4-week clerkship, and 60 (33.5%) completed the 8-week clerkship.</p> Key Results <p>The mean ORIME score was 2.70 (SD = 0.42) for students undertaking the 4-week clerkship and 2.87 (SD = 0.38) for students in the 8-week clerkship (<i>p</i> = 0.01; Cohen’s d = 0.41). Students in the 8-week clerkship achieved Interpreter level (ORIME = 3.0) after 8 weeks of prior IM-aligned or 12 weeks of any prior clinical exposure. Students in the 4-week clerkship achieved Interpreter level after 12 to 16 weeks of prior IM-aligned or 24 to 28 weeks of any prior clinical exposure.</p> Conclusions <p>Medical students achieved Interpreter level with an average of 16 to 20 weeks of cumulative clinical exposure to IM-aligned specialties. Students enrolled in the 8-week version of the clerkship achieved Interpreter level more rapidly than students in the 4-week version, suggesting that continuity in IM training is impactful.</p>

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How Much Time is Enough? Evaluating Clinical Performance in a Time-Variable Internal Medicine Clerkship

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Amy J. Kwon,
  • Quiana Harshman,
  • Patricio A. Riquelme,
  • Sima Desai,
  • Patricia A. Carney

摘要

Objective

The length of internal medicine (IM) clerkships has decreased over time, with unclear impact on clinical performance metrics. The ORIME (Observer-Reporter-Interpreter-Manager-Educator) framework was used to assess the impact of different IM clerkship lengths and how completion of prior clerkships affected students’ IM clinical performance.

Design

Between 1/25/21 and 3/22/24, physician evaluators rated clerkship students’ clinical performance using the ORIME scale (Scale: 1 = Observer/Pre-Reporter; 2 = Reporter; 3 = Interpreter; 4 = Manager). Comparisons were made between final ORIME scores for students in four- and eight-week versions of the clerkship, as well as for cumulative clinical exposure time across IM-aligned specialties and all specialties.

Participants

Of the 179 third-year medical students participating in the study, 119 (66.5%) completed the 4-week clerkship, and 60 (33.5%) completed the 8-week clerkship.

Key Results

The mean ORIME score was 2.70 (SD = 0.42) for students undertaking the 4-week clerkship and 2.87 (SD = 0.38) for students in the 8-week clerkship (p = 0.01; Cohen’s d = 0.41). Students in the 8-week clerkship achieved Interpreter level (ORIME = 3.0) after 8 weeks of prior IM-aligned or 12 weeks of any prior clinical exposure. Students in the 4-week clerkship achieved Interpreter level after 12 to 16 weeks of prior IM-aligned or 24 to 28 weeks of any prior clinical exposure.

Conclusions

Medical students achieved Interpreter level with an average of 16 to 20 weeks of cumulative clinical exposure to IM-aligned specialties. Students enrolled in the 8-week version of the clerkship achieved Interpreter level more rapidly than students in the 4-week version, suggesting that continuity in IM training is impactful.