The Influence of Clinical Clerkship Rotation Sequence on Emergency Simulation Performance: A Cohort Study on Sixth-year Medical Students

Aim: The length and sequence of clinical clerkship rotations are essential factors that influence student learning outcomes and clinical performance.This study aimed to investigate whether clerkship sequences influence the performance of sixth-year medical students in emergency simulations of life-threatening scenarios. Materials and Methods:This retrospective observational cohort study, conducted at our academic institution during the academic year 2024-2025, involved 334 sixth-year medical students divided into two groups based on initial clerkship general surgery (n=169) or general medicine (n=165) who switched at mid-year.Student performance was assessed by the emergency medicine faculty across five competency domains on a 0-5 scale during two high-fidelity emergency simulation scenarios: major trauma and acute myocardial infarction (AMI).Mann-Whitney U test was used to compare performances.Results: Median scores across the performance domains clinical assessment, critical thinking, patient care, communication, and professional behavior were similar between the student groups in both simulations, with median scores ranging from 1 to 4. In the AMI scenario, surgeryfirst students had slightly higher overall median scores [13, interquartile range (IQR): 11-15] than medicine-first students (12, IQR: 10-15).However, the Mann-Whitney U test showed no statistically significant differences for either the AMI (p=0.120-0.86)or the trauma simulations (p=0.542-0.742).Conclusion: Our study indicates that the order of clinical clerkship rotations did not significantly affect sixth-year medical students' performance in emergency simulations involving life-threatening cases.These findings inform ongoing discussions on optimizing medical education curricula.We recommend further research across multiple institutions to explore the effects of clerkship sequencing in greater detail.