Examining the Impact of Pairing Medical Students Together on Clinical Teams

Abstract

Purpose: Medical students are often paired together on clinical teams during their clerkships, but this practice has not been previously investigated. The primary objectives of this study were (1) to retrospectively assess whether pairing students on medical teams during their sub-internship affected their grade, (2) to survey medical students’ attitudes and preferences towards pairing, and (3) to understand which factors of the learning environment may alter student attitudes and perceptions towards the practice of pairing. Methods: We analyzed 186 student pairings within the medicine sub-internship at 3 hospital sites of Harvard Medical School from 2013-2017. Employing contingency table analysis, we examined categorical grading data comparing expected and observed grading distributions, controlling for performance from the third year internal medicine clerkship. In addition, we developed and administered a survey assessing student attitudes and perceptions on pairing to the 2018 graduating class of Harvard Medical School (HMS). We conducted 17 semi- structured interviews of HMS students. Three investigators analyzed the transcripts using a structured qualitative framework approach, which was informed by literature on sociocultural theory and the clinical learning environment. Results: Among 186 student-pairs, there was no deviation between the expected and observed distribution of student grades, even when controlling for prior internal medicine clerkship performance (p=0.28), suggesting that pairing had no effect on the sub-internship grade. Ninety-nine students responded to the survey (59% response rate). Ninety percent and 87% of respondents felt that being paired affected their evaluations by resident and attending physicians, respectively. Through our interviews, we identified five domains of factors that can alter a student’s experience with their partner on clerkships: intra-student factors, partner factors, clinical team factors, student-team dynamics, and student-partner dynamics. Conclusion: This analysis suggests that pairing medical students together on clerkships may not affect student grades, despite the majority of surveyed students believing that being paired affects their evaluations. Multiple factors can influence the students’ attitudes towards pairing. Awareness of student perceptions regarding pairing can inform clerkship structure and be utilized to address student concerns. Interventions aimed at improving the pairing dynamic between students may hold promise for enhanced peer teaching and support during clinical clerkships.