PURPOSE
The purpose of this study was to identify the causal relationship between the following variables: basic science score, written examination score (Internal medicine and Pediatrics), clinical clerkship score (Internal medicine and Pediatrics), and affective factors (self-efficacy, anxiety, and perception of preparedness). METHODS: Forty-two medical students took the clinical performance examination (CPX) at the end of the first semester. One day before the CPX, the students completed a brief survey, which included 11 items that sampled their self-efficacy, preparedness and anxiety with regard to the CPX. The responses from the 38 identifiable surveys (90%), out of 42, were analyzed for this study. Structural equation modeling techniques were used to test the relationships between the variables. The students' basic science scores, clinical clerkship scores, and written examination scores were considered for this study. RESULTS: We found that self-efficacy influenced students' CPX scores indirectly through their preparedness and anxiety. Preparedness influenced students' CPX scores indirectly through their anxiety. Anxiety was predicated on self-efficacy directly or indirectly and it predicted CPX scores. The clinical clerkship scores affected the students' CPX scores indirectly. The written examination scores and basic science scores, however, did not impact the students' CPX scores directly or indirectly. The basic science scores, clinical clerkship scores, and written examination scores were not associated with self-efficacy. CONCLUSION: Our findings highlight the importance of clinical clerkship education and reasonable medical teaching methods in improving the student self-efficacy for the CPX.
