Prematriculation Healthcare Employment Predicts Success in Clerkship Environment

Abstract

Purpose: The average age of the matriculating medical student is increasing as more students take time between college and medical school. Increasing numbers of students are employed in the healthcare field during these gap years. Studies have explored the relationship between matriculation age and medical school performance with conflicting findings. The impact of prior healthcare employment (PHE) on future clerkship performance has not been explored. We hypothesize that medical school performance metrics would be higher for students with PHE than their peers. Methods: A retrospective review of four medical school classes at a single institution was conducted. Each student’s admission application was examined to identify students with at least 6 months paid employment in a clinical healthcare position (i.e., pre-matriculation direct patient interaction, PHE cohort). Multiple medical school performance metrics were obtained for each student. Results: Of the 434 included students, 49 were PHE (11.29%) and percent of students with PHE trended up over time. MCAT scores, USMLE Step 1, and Step 2 CK scores were not different for PHE and non-PHE medical students. PHE students had significantly higher NBME subject exams, clinical clerkship scores, and cumulative year 3 performance. Conclusions: Students who matriculate to medical school with prior healthcare employment outperform their peers in the clinical environment, possibly due to acquisition of knowledge or skills from their prior employment. These findings support students seeking paid healthcare experiences prior to medical school and have implications for pre-medicine advising, admissions, and medical school curricula.