Does volume of patients seen in an outpatient setting impact test scores?

BACKGROUND: Methods of teaching surgery in the outpatient setting and means to measure the effectiveness of these methods have not been defined. This study was designed to evaluate the impact of number of outpatient encounters on test scores for third-year medical students. METHODS: Students rotating on the required third-year surgery clerkship between July 1994 and June 1996 kept a log of their activities including number of patients seen in clinic, number of cases scrubbed, and pages read. At the end of the rotation the students were given an essay examination and a multiple-choice examination. The data were analyzed looking for correlation between examination scores and volume of patients seen. United States Medical Licensing Examination (USMLE) Step 1 scores were used as a baseline measure to compare the rotation groups. RESULTS: USMLE scores did not differ between groups. Mean essay examination scores varied significantly between some rotation groups, but did not follow a pattern. There was no correlation between the number of patients seen in clinic and essay examination scores. There was a significant correlation between essay score and USMLE Step 1 score (Pearson's r = 0.398) and between essay and multiple-choice examination scores (Pearson's r = 0.313). There was a significant negative correlation between number of patients seen in clinic and number of cases scrubbed (Pearson's r = -0.347). CONCLUSIONS: Participation in outpatient surgery clinics did not result in improved performance on written examinations in this surgery clerkship. To achieve the most benefit from the outpatient clinic, objectives of the experience need to be determined and appropriate tools used to measure their successful achievement.