The effect of psychiatric third-year rotation setting on academic performance, student attitudes, and specialty choice

Objective: Few studies have directly compared the effects of third-year clerkship rotation type on measures of academic performance, student attitudes about psychiatry and psychiatric patients, and level of interest in psychiatry as a career. The goal of this study was to assess the extent to which rotation type influenced these outcome variables among third-year medical students. Methods: The authors conducted a prospective study of 647 third-year medical students administratively assigned to one of three clinical settings: an acute inpatient ward, a hospital-based consultation-liaison service, and an outpatient mental health care clinic. Academic performance was estimated using scores from a nationally standardized examination provided by the National Board of Medical Examiners (NBME), while responses to an anonymous survey developed by the investigators were used as indicators of student attitudes about and interest in psychiatry as a potential career field. Administrative residency match data were collected on all participants. Results: Rotation type had no effect on NBME exam scores after controlling for grade point average, age, gender, rotation order, and rotation year. Although individuals who rotated on the inpatient service scored an average of 1.8 points higher on the examination relative to individuals who rotated on the consultation service, this small difference was not considered academically meaningful. Similarly, there were no statistically meaningful patterns that emerged between survey responses and rotation type. Approximately 4% of our sample matched into psychiatric residencies after graduating from medical school. Rotation type and survey responses were not statistically correlated with specialty choice. Conclusion: Rotation type does not appear to affect acquisition of psychiatric knowledge as estimated by standardized examination scores, nor does it appear to influence students' perceptions of psychiatry or specialty choice.