Evaluation of a Single Year Competency-Based Clerkship Alternative to Effectively Navigate a Fourth-Year to Third Year Curricular Transition (P2.002)

Objective: -Share the curricular design process and feasibility of implementation of a competency-based test-out option for a required neurology clerkship during a transition year -Evaluate the effectiveness of a competency-based test-out option for a neurology clerkship Background: As OHSU underwent UME curricular transformation, the neurology clerkship transferred from a fourth-year required clerkship to a third-year required clerkship. This led to a single year ‘bulge’ of students during the transition involving the first class of the new curriculum and the last class of the old curriculum. Design/Methods: A novel solution by the neurology clerkship leadership was accepted by the OHSU UME curriculum committee. For AY16–17 fourth-year students were allowed to test out of neurology by passing the NBME shelf examination in clinical neurology and completing a faculty-observed history and complete neurological examination. Test-out students were given access to all clerkship online resources including the AAN medical student SAE to prepare for assessments. Effectiveness of the test-out option was assessed by NBME shelf examination performance in both groups. All students completed an end-of-course evaluation and a focus group discussed the course with an OHSU UME curriculum committee liaison. Results: Of fourth-year students AY16–17, 57 chose to complete the required neurology clerkship and 77 chose the test-out option. The mean NBME shelf exam raw score was 77.6 for clerkship versus 76.9 for those who took the test-out option (difference non-significant at p=0.30). Test-out option students were satisfied with the experience, and enjoyed the flexibility it allowed in schedule. A theme from the focus group was that students who tested-out felt that they did miss valuable clinical experience on the neurology clerkship. Conclusions: As there are many medical schools currently undergoing similar curricular changes, so this challenge is not unique to OHSU. This option alleviates already taxed clinical site resources without adversely affecting NBME shelf examination scores. Disclosure: Dr Kraakevik has nothing to disclose. Dr. Frederick has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. Carney has nothing to disclose.