A Comparison of Performance Evaluations of Students on Longitudinal Integrated Clerkships and Rotation-Based Clerkships

Background Longitudinal integrated clerkship (LIC) students typically perform as well as, if not better than, rotation-based clerkship (RBC) students on objective evaluations, yet few studies have compared performance in the clinical setting. This study compared in-training evaluation report (ITER) ratings of LIC and RBC students, including their correlation with more objective evaluations. Method On the basis of prior academic performance, LIC students (n = 27) at Universities of Alberta, British Columbia, and Calgary were matched with four RBC students from their center. The authors compared reliability of ITER ratings, ITER ratings of clinical skills and professional attributes, and the correlation between ITER ratings and objective evaluations of clinical skills and professional attributes on the Medical Council of Canada Qualifying Examination (MCCQE) Part I. Results ITER ratings of LIC students were more reliable and significantly higher than those of RBC students for both clinical skills and professional attributes. However, LIC students had lower objective structured clinical examination scores and weaker correlations between subjective and objective evaluations of clinical skills. By comparison, LIC students scored higher on a particular component of the MCCQE and had stronger correlations between subjective and objective evaluations of professionalism. Conclusions The discrepancy between ratings of LIC students' clinical skills on ITER and other evaluation formats may be due to differences between the content of training and objective evaluations, or systematic rater biases. Further studies are needed to confirm and explain these findings. Promisingly, our data suggest that the LIC model may allow for a more predictive evaluation of professional competencies.