Upon completing a clinical clerkship, some students demonstrate adequate clinical skills appropriate for that clerkship but do not demonstrate an adequate fund of knowledge or ability to apply their knowledge clinically. For such students, repeating all or a portion of the clerkship may not be appropriate. This study describes a tutorial provided such students after they had completed the medicine clerkship at the Oregon Health Sciences University. During a two-year period (academic years 1988-89 and 1989-90), six students were identified as needing remediation, and were enrolled in a tutorial coordinated by one faculty member with support from others. The experience was highly successful for all but one student, and the tutorial was uniformly viewed by the students who took it as one of their best experiences in medical school.

This article reports the results of a survey of the 124 medical schools in the United States and Puerto Rico, mailed in late 1986; the majority of the responses from 101 schools were received in early 1987. The authors report their findings concerning the overall process used by these schools to evaluate medicine clerks, specifically identifying the importance given to subjective evaluations, made by attending physicians and/or housestaff, compared with the importance given to clerks' performances on objective means of evaluation based on written and/or oral examinations, whether national or faculty-developed. The study reveals that the subjective evaluations of clerks by faculty attending physicians and by housestaff working with the clerks were used by 98 and 83 of the responding schools, respectively, and were given the greatest evaluative weight. Examinations of all types were used by 87 of the responding schools. The National Board of Medical Examiners (NBME) Part II Medicine Examination was the most frequently used and heavily weighted examination, followed by written faculty examinations. Oral examinations were the least frequently used evaluative tools, carried the least weight, and were rarely used without another examination. In light of their findings, the authors maintain that further research should be done to clarify whether the NBME Part II Medicine Examination is an appropriate instrument to measure the knowledge acquired during clerkship experiences.

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