Increase in medical knowledge during the final year of undergraduate medical education in Germany

Aims: In Germany, the final year of undergraduate medical education (‘practice year’) consists of three 16-week clinical attachments, two of which are internal medicine and surgery. Students can choose a specific specialty for their third 16-week attachment. Practice year students do not receive specific teaching to prepare them for the National Licensing Examination. It is unknown whether knowledge levels increase during this year. This study aimed at assessing knowledge at the beginning and the end of the final year of medical school. Methods: Three hundred pre-selected United States Medical Licensing Examination type items from ten medical disciplines were reviewed by ten recent medical graduates from the Netherlands and Germany. The resulting test included 150 items and was taken by 77 and 79 final year medical students from Göttingen and Hamburg at the beginning and the end of their practice year, respectively. Results: Cronbach’s α of the pre- and post-test was 0.75 and 0.68, respectively. Mean percent scores in the pre- and post-test were 63.9±6.9 and 69.4±5.7, respectively (p<0.001; effect size calculated as Cohen’s d: 0.87). In individual students, post-test scores were particularly high for items related to their specific chosen specialty. Conclusion: The knowledge test used in this study provides a suitable external tool to assess progress of undergraduate medical students in their knowledge during the practice year. The pre-test may be used to guide individual learning behaviour during this final year of undergraduate education.