| Medical education is a multi-stage process traditionally consisting of two years of basic science education, two years of clinical science education, and at least three years of residency training. This highly structured and purposeful professional education presumes that there is a continuity from one level of training to another. The advanced levels of training are assumed to be built upon the foundations laid in the previous levels with all levels contributing to the development of professional competence.;This study evaluates medical education by assessing the growth of medical knowledge from the end of preclinical education to the end of the first year of residency. The holistic approach this study employs conceptualizes knowledge of basic sciences and knowledge of clinical sciences as components of a more general cognitive construct: General Medical Knowledge (GMK). GMK is operationalized by a measurement scale constructed by equating the National Board of Osteopathic Medical Examiners (NBOME) Part I, II, and III Examinations. Rasch model one-step equating method accomplishes this vertical equating.;Students' GMK changes are modelled as a three-level phenomenon and analyzed longitudinally by Hierarchical Linear Models (HLM). Individual growth trajectories constitute the Level-1 model. The Level-2 and Level-3 models represent the variation in growth parameters within schools and between schools respectively.;The results suggest that the GMK growth is not linear. Although the overall growth is significant from the end of preclinical education to the end of the first year of residency, average students' medical knowledge does not grow during clinical education. The zero growth during clinical education implies that, to a certain extent, a discontinuity exists between preclinical and clinical education.;The medical achievement growth varies significantly at both student and school levels. Gender, school sector, type of preclinical curriculum, and quality of clinical education all significantly affect the GMK growth.;Two types of growth patterns exist at school level. For some schools, mean GMK grows continuously, while for others, the growth shows a concave pattern with a substantial decline during clinical education. In this study school sector discriminates the growth patterns at school level. |
