Clerkship order and performance on family medicine and internal medicine National Board of Medical Examiners exams

Background and Objectives: Taking National Board of Medical Examiners (NBME) subject examinations later in the year is known to lead to higher scores. The effect of taking these exams in a particular order is not well understood. Methods: Scores on family medicine and internal medicine examinations from 312 students in 2 academic years were analyzed to determine the effect of clerkship order on student performance. US Medical Licensing Examination (USMLE) Step 1 scores were used to control for prior academic achievement. Students were separated into groups based on the time of year the), took each clerkship and prior experiences. Results: When controlling for USMLE scores, NBME scores varied in relation to time of year and order of clerkship experiences. Students who took internal medicine first performed better on the family medicine exam. Taking psychiatry, obstetrics-gynecology, or surgery clerkships prior to the internal medicine exam improved scores on the internal medicine examination. Conclusions: The timing and order of family medicine and internal medicine clerkship experiences affects performance on the NBME family medicine and internal medicine exams. Clerkship directors should consider this effect when evaluating medical students.