Pairing medical students on the wards: A multi-site analysis of pairing effect on clerkship performance

Background: Medical students are often paired together on clinical teams during their clerkships. While this practice has multiple potential positive effects, evidence suggests that most students feel that their evaluation is impacted by the other student. This perception negatively impacts the learning environment. We set out to determine whether paired students had a measurable effect on each other’s clerkship grade during the medicine sub-internship. Method: We examined 186 4th year student-pairs during the required medicine sub-internship at 3 hospital sites of Harvard Medical School from 2013–2017. Chi-square tests were used to determine whether pairing impacted the final clerkship grade. Subsequently we examined whether pairing impacted the sub-internship performance stratified by students’ 3rd year core medicine clerkship grade to account for prior performance. Findings: We found no significant deviation between the expected and observed distribution of student grades (chi-square 1.9, p = 0.39) among 186 student pairs, suggesting that pairing had no meaningful effect on the sub-internship grade. We also saw no significant effect of pairing when controlling for prior internal medicine clerkship performance (chi-square 10.9, p = 0.53). Conclusions: Despite concerns that students on the same medical team may impact each other’s performance evaluation, our exploratory study demonstrated no significant effect of student pairing on grades in a medicine sub-internship. Further study of the complex relationship between students on a medical team are warranted to optimize this common practice and enhance the learning environment.