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Under the aegis of curricular reform, our institution reduced the length of the psychiatry clinical clerkship from 4 week to 3 weeks, making it the shortest psychiatry clerkship in North America. A 3-week elective was created for those students who desired additional exposure to psychiatry.
Medical educators--especially those in psychiatry--have debated for many years the appropriate lengths for core clerkships, with debate focusing on the minimal number of weeks required to acquire essential clinical skills and knowledge. In response to the declining lengths of many American psychiatry clerkships and the lack of standardization of length, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) published a position statement in 2006, stating that a rotation "must be at least 6 weeks in length or longer" to develop the skills necessary to recognize and appropriately manage psychiatric illnesses (1). Although both median and average American clerkship lengths are 6 weeks, individual lengths range from 3 to 8 weeks.
Although investigators disagree about whether shelf exams measure clinical skills, they are the only nearly-universal objective measure of psychiatric knowledge. Limited published reports reveal no consistent association between clerkship length and shelf-exam score for 6- to 8-week clerkships (2, 3). When rotation lengths are shorter, clerkship directors have been found to weigh PSE scores more than clinical performance (4), suggesting that reducing psychiatry clerkship length may result in a greater emphasis on standardized test scores than on interviewing and communication skills, crucial components in psychiatric diagnosis. Although shorter psychiatry clerkships do not necessarily influence psychiatry recruitment (5), future nonpsychiatrists in a shorter psychiatry clerkship get less exposure to psychiatric issues and diagnoses affecting patients in all medical and surgical specialties.
In light of this data and the ultra-short psychiatry clerkship at our institution, we grew concerned about the adverse impact this curricular reform might be having on our graduates' psychiatry knowledge. We sought to compare differences in our students' performances on the required psychiatry shelf exam (PSE), based on clerkship length.
Method
We collected PSE scores on all medical students who completed the third-year psychiatry core clerkship between the years 1998 and 2010. We correlated this data with the weeks of psychiatry clerkship: 3, 4, or 6 weeks, experienced by the student before taking the exam....