Subbing in: Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes

Alyssa L. MacMahon; Meaghan S. Wido; Steven J. Durning; Sami A. Abuhamdeh

doi:10.1007/s40670-026-02651-5

Subbing in: Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes

Alyssa L. MacMahon^*
, Meaghan S. Wido
, Steven J. Durning
, Sami A. Abuhamdeh

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Clinical experiences foster medical students' clinical reasoning and professional identity. When real patient encounters are not available, students often utilize screen-based simulation. While screen-based substitutions can be a comparable alternative (Meyer et al. Acad Psychiatry 47:181-186, 2023; Patel et al. Cureus 16:e54541, 2024), there is less clarity regarding frequency and type of experiences students substitute with simulation and how this relates to clinical competencies.

OBJECTIVE: This retrospective study seeks to quantify the trends of screen-based substitutions among pediatric clerkship students and investigate associations between substitutions and performance outcomes.

METHODS: Data were collected from the Uniformed Services University, Department of Pediatrics archival records (2018-2023) of students ( N = 884) tracked clinical experiences, scores on the National Board of Medical Examiners ® (NBME) Pediatrics Subject exam, and a written History and Physical (H&P) exam. Analysis included descriptive statistics of clinical substitutions by type, location, and over time. Regression analysis compared the number of substitutions and performance outcomes.

RESULTS: Students substituted a mean of 0.79 (SD = 1.08) out of the 12 required clinical experiences. Acute Gastroenteritis was consistently and frequently substituted. Overall, substitutions increased significantly in 2020 compared to 2018 and 2019. There was a small but significant negative relationship between number of substitutions and NBME scores ( β = -.06, p < .05), but no significant relationship with H&P scores ( β = .02, p = .40).

CONCLUSION: Increased use of substitutions since 2020 raises concerns about limitations in students' exposure to core clinical experiences. However, the minimal association between substitutions and performance outcomes suggests screen-based substitutions are still a reasonable alternative.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-026-02651-5.

Original language	English
Pages (from-to)	829-837
Number of pages	9
Journal	Medical Science Educator
Volume	36
Issue number	2
DOIs	https://doi.org/10.1007/s40670-026-02651-5
State	Published - Apr 2026

Keywords

Clinical substitutions
Medical education
Pediatrics clerkship
Performance outcomes

Access to Document

10.1007/s40670-026-02651-5

Cite this

@article{be4c8f7427424afb882891bad06e10c3,

title = "Subbing in: Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes",

abstract = "BACKGROUND: Clinical experiences foster medical students' clinical reasoning and professional identity. When real patient encounters are not available, students often utilize screen-based simulation. While screen-based substitutions can be a comparable alternative (Meyer et al. Acad Psychiatry 47:181-186, 2023; Patel et al. Cureus 16:e54541, 2024), there is less clarity regarding frequency and type of experiences students substitute with simulation and how this relates to clinical competencies.OBJECTIVE: This retrospective study seeks to quantify the trends of screen-based substitutions among pediatric clerkship students and investigate associations between substitutions and performance outcomes.METHODS: Data were collected from the Uniformed Services University, Department of Pediatrics archival records (2018-2023) of students ( N = 884) tracked clinical experiences, scores on the National Board of Medical Examiners {\textregistered} (NBME) Pediatrics Subject exam, and a written History and Physical (H\&P) exam. Analysis included descriptive statistics of clinical substitutions by type, location, and over time. Regression analysis compared the number of substitutions and performance outcomes. RESULTS: Students substituted a mean of 0.79 (SD = 1.08) out of the 12 required clinical experiences. Acute Gastroenteritis was consistently and frequently substituted. Overall, substitutions increased significantly in 2020 compared to 2018 and 2019. There was a small but significant negative relationship between number of substitutions and NBME scores ( β = -.06, p < .05), but no significant relationship with H\&P scores ( β = .02, p = .40). CONCLUSION: Increased use of substitutions since 2020 raises concerns about limitations in students' exposure to core clinical experiences. However, the minimal association between substitutions and performance outcomes suggests screen-based substitutions are still a reasonable alternative.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-026-02651-5.",

keywords = "Clinical substitutions, Medical education, Pediatrics clerkship, Performance outcomes",

author = "MacMahon, \{Alyssa L.\} and Wido, \{Meaghan S.\} and Durning, \{Steven J.\} and Abuhamdeh, \{Sami A.\}",

note = "{\textcopyright} This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2026.",

year = "2026",

month = apr,

doi = "10.1007/s40670-026-02651-5",

language = "English",

volume = "36",

pages = "829--837",

journal = "Medical Science Educator",

issn = "2156-8650",

publisher = "Springer New York",

number = "2",

}

TY - JOUR

T1 - Subbing in

T2 - Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes

AU - MacMahon, Alyssa L.

AU - Wido, Meaghan S.

AU - Durning, Steven J.

AU - Abuhamdeh, Sami A.

N1 - © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2026.

PY - 2026/4

Y1 - 2026/4

N2 - BACKGROUND: Clinical experiences foster medical students' clinical reasoning and professional identity. When real patient encounters are not available, students often utilize screen-based simulation. While screen-based substitutions can be a comparable alternative (Meyer et al. Acad Psychiatry 47:181-186, 2023; Patel et al. Cureus 16:e54541, 2024), there is less clarity regarding frequency and type of experiences students substitute with simulation and how this relates to clinical competencies.OBJECTIVE: This retrospective study seeks to quantify the trends of screen-based substitutions among pediatric clerkship students and investigate associations between substitutions and performance outcomes.METHODS: Data were collected from the Uniformed Services University, Department of Pediatrics archival records (2018-2023) of students ( N = 884) tracked clinical experiences, scores on the National Board of Medical Examiners ® (NBME) Pediatrics Subject exam, and a written History and Physical (H&P) exam. Analysis included descriptive statistics of clinical substitutions by type, location, and over time. Regression analysis compared the number of substitutions and performance outcomes. RESULTS: Students substituted a mean of 0.79 (SD = 1.08) out of the 12 required clinical experiences. Acute Gastroenteritis was consistently and frequently substituted. Overall, substitutions increased significantly in 2020 compared to 2018 and 2019. There was a small but significant negative relationship between number of substitutions and NBME scores ( β = -.06, p < .05), but no significant relationship with H&P scores ( β = .02, p = .40). CONCLUSION: Increased use of substitutions since 2020 raises concerns about limitations in students' exposure to core clinical experiences. However, the minimal association between substitutions and performance outcomes suggests screen-based substitutions are still a reasonable alternative.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-026-02651-5.

AB - BACKGROUND: Clinical experiences foster medical students' clinical reasoning and professional identity. When real patient encounters are not available, students often utilize screen-based simulation. While screen-based substitutions can be a comparable alternative (Meyer et al. Acad Psychiatry 47:181-186, 2023; Patel et al. Cureus 16:e54541, 2024), there is less clarity regarding frequency and type of experiences students substitute with simulation and how this relates to clinical competencies.OBJECTIVE: This retrospective study seeks to quantify the trends of screen-based substitutions among pediatric clerkship students and investigate associations between substitutions and performance outcomes.METHODS: Data were collected from the Uniformed Services University, Department of Pediatrics archival records (2018-2023) of students ( N = 884) tracked clinical experiences, scores on the National Board of Medical Examiners ® (NBME) Pediatrics Subject exam, and a written History and Physical (H&P) exam. Analysis included descriptive statistics of clinical substitutions by type, location, and over time. Regression analysis compared the number of substitutions and performance outcomes. RESULTS: Students substituted a mean of 0.79 (SD = 1.08) out of the 12 required clinical experiences. Acute Gastroenteritis was consistently and frequently substituted. Overall, substitutions increased significantly in 2020 compared to 2018 and 2019. There was a small but significant negative relationship between number of substitutions and NBME scores ( β = -.06, p < .05), but no significant relationship with H&P scores ( β = .02, p = .40). CONCLUSION: Increased use of substitutions since 2020 raises concerns about limitations in students' exposure to core clinical experiences. However, the minimal association between substitutions and performance outcomes suggests screen-based substitutions are still a reasonable alternative.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-026-02651-5.

KW - Clinical substitutions

KW - Medical education

KW - Pediatrics clerkship

KW - Performance outcomes

UR - https://www.scopus.com/pages/publications/105031418894

U2 - 10.1007/s40670-026-02651-5

DO - 10.1007/s40670-026-02651-5

M3 - Article

C2 - 42183456

AN - SCOPUS:105031418894

SN - 2156-8650

VL - 36

SP - 829

EP - 837

JO - Medical Science Educator

JF - Medical Science Educator

IS - 2

ER -

Subbing in: Associations Between Screen-Based Clinical Substitutions and Pediatric Clerkship Performance Outcomes

Abstract

Keywords

Access to Document

Fingerprint

Cite this