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Variation and imprecision of clerkship grading in U.S. medical schools.

Abstract

PURPOSE
Despite standardized curricula and mandated accreditation, concern exists regarding the variability and imprecision of medical student evaluation. The authors set out to perform a complete review of clerkship evaluation in U.S. medical schools.
METHOD
Clerkship evaluation data were obtained from all Association of American Medical Colleges-affiliated medical schools reporting enrollment during 2009-2010. Deidentified reports were analyzed to define the grading system and the percentage of each class within each grading tier. Inter- and intraschool grading variation was assessed in part by comparing the proportion of students receiving the top grade.
RESULTS
Data were analyzed from 119 of 123 accredited medical schools. Dramatic variation was detected. Specifically, the authors documented eight different grading systems using 27 unique sets of descriptive terminology. Imprecision of grading was apparent. Institutions frequently used the same wording (e.g., "honors") to imply different meanings. The percentage of students awarded the top grade in any clerkship exhibited extreme variability (range 2%-93%) from school to school, as well as from clerkship to clerkship within the same school (range 18%-81%). Ninety-seven percent of all U.S. clerkship students were awarded one of the top three grades regardless of the number of grading tiers. Nationally, less than 1% of students failed any required clerkship.
CONCLUSIONS
There exists great heterogeneity of grading systems and imprecision of grade meaning throughout the U.S. medical education system. Systematic changes seeking to increase consistency, transparency, and reliability of grade meaning are needed to improve the student evaluation process at the national level.

Links

  • Publisher Full Text

    • Authors

    Alexander EK, Osman NY, Walling JL, Mitchell VG

    Institution

    Brigham and Women's Hospital, Boston, MA 02115, USA. ekalexander@partners.org

    Source

    Academic medicine : journal of the Association of American Medical Colleges 87:8 2012 Aug pg 1070-6

    MeSH

    Achievement
    Clinical Clerkship
    Clinical Competence
    Curriculum
    Education, Medical
    Educational Measurement
    Humans
    Questionnaires
    Schools, Medical
    United States

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22722356