Clerkship Evaluations
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What do faculty observe of medical students’ clinical performance?
Department of Surgery, University of Kentucky College of Medicine, Lexington, 40536, USA. arpuli@uky.edu
BACKGROUND: An earlier study of our faculty’s evaluation of junior medical students indicated that performance ratings were unreliable and reflected 1 underlying dimension. Other researchers have obtained similar results. PURPOSE: The purpose of this study was to identify which aspects of students’ clinical performance faculty actually observe. METHODS: We analyzed the responses of 9 faculty members to an open-ended questionnaire concerning which aspects of clinical performance attending faculty observe. We also reviewed and summarized the written comments of 331 faculty evaluations of third-year medical students. RESULTS: Analysis of the questionnaires and evaluations indicated that faculty members gauge medical knowledge, professionalism, and clinical reasoning skills from direct interaction with students. History-taking and physical examination skills are inferred from the quality of verbal presentations. Faculty have little basis for evaluating other important aspects of clinical performance. CONCLUSIONS: Faculty primarily observe medical students’ cognitive skills and professionalism. Faculty have little basis for evaluating most other features of clinical performance.
PMID: 16626266 [PubMed - indexed for MEDLINE]
Categorised as: Uncategorized
http://www.ncbi.nlm.nih.gov/pubmed/17987918?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
1: J Natl Med Assoc. 2007 Oct;99(10):1138-50.Links
“Making the grade:” noncognitive predictors of medical students’ clinical clerkship grades.Lee KB, Vaishnavi SN, Lau SK, Andriole DA, Jeffe DB.
Washington University School of Medicine, St. Louis, MO 63108, USA. leeka@msnotes.wustl.edu
OBJECTIVES: Because clinical clerkship grades are associated with resident selection and performance and are largely based on residents’/attendings’ subjective ratings, it is important to identify variables associated with clinical clerkship grades. METHODS: U.S. medical students who completed > or =1 of the following required clinical clerkships–internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology and psychiatry–were invited to participate in an anonymous online survey, which inquired about demographics, degree program, perceived quality of clerkship experiences, assertiveness, reticence and clerkship grades. RESULTS: A total of 2395 medical students (55% women; 57% whites) from 105 schools responded. Multivariable logistic regression models identified factors independently associated with receiving lower clerkship grades (high pass/pass or B/C) compared with the highest grade (honors or A). Students reporting higher quality of clerkship experiences were less likely to report lower grades in all clerkships. Older students more likely reported lower grades in internal medicine (P = 0.02) and neurology (P < 0.001). Underrepresented minorities more likely reported lower grades in all clerkships (P < 0.001); Asians more likely reported lower grades in obstetrics/gynecology (P = 0.007), pediatrics (P = 0.01) and neurology (P = 0.01). Men more likely reported lower grades in obstetrics/gynecology (P < 0.001) and psychiatry (P = 0.004). Students reporting greater reticence more likely reported lower grades in internal medicine (P = 0.02), pediatrics (P = 0.02) and psychiatry (P < 0.05). Students reporting greater assertiveness less likely reported lower grades in all clerkships (P < 0.03) except IM. CONCLUSIONS: The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation.
PMID: 17987918 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/17716605?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
1: J Surg Res. 2007 Sep;142(1):7-12. Links
Perspectives of third-year medical students toward their surgical clerkship and a surgical career.Goldin SB, Wahi MM, Wiegand LR, Carpenter HL, Borgman HA, Lacivita Nixon L, Rosemurgy AS 2nd, Karl RC.
Department of Surgery, University of South Florida College of Medicine, Tampa, Florida 33612, USA. sgoldin@hsc.usf.edu
INTRODUCTION: A deficit of surgeons currently exists in the health care workforce. We have designed a study that identifies predictors of students choosing a career in surgery. First, we conducted two feasibility studies, and on the basis of these data, designed a third study for addressing our specific aims. The design and one-year results for the new study are provided here. METHODS: For the feasibility studies, students participating in the third-year surgery clerkship at our institution were asked to complete surveys using two different study designs. For the new study, which began in June 2005, students complete surveys covering domains of interest at the beginning of the clerkship and at weekly intervals throughout the clerkship, and will be providing match results. RESULTS: The feasibility studies offered insight into ways to improve our study design. In the first year of this multi-year study, 93 students participated (response rate = 77%). Forty-five students were women (48%), and the average age was 26.09 (sd 2.85). Proportion of students rating general surgery or a surgery subspecialty in their top three choices for a career increased over the course of the clerkship by 24.7% (n = 32, 34.4% at baseline; n = 55, 59.1% at end of clerkship). Seventy-one students (76.3%) reported having a meaningful experience on the clerkship, and 30 (32.3%) received honors grades. CONCLUSION: Our study design benefitted from the knowledge we gained from our feasibility studies. We look forward to achieving the necessary sample size in the next several years to report the final results of this study.
PMID: 17716605 [PubMed - indexed for MEDLINE]
1: J Gen Intern Med. 2007 Aug;22(8):1101-6. Epub 2007 May 11. Links
Prolonged delays for research training in medical school are associated with poorer subsequent clinical knowledge.Dyrbye LN, Thomas MR, Natt N, Rohren CH.
Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55906, USA. dyrbye.liselotte@mayo.edu
BACKGROUND: Complementary degree programs and research training are important alternative tracks in medical school that typically interrupt the traditional MD curriculum. OBJECTIVE: Examine effects of such a break on clinical knowledge after reentry into the MD curriculum. DESIGN: Retrospective cohort study. PARTICIPANTS: Three hundred and two graduates of Mayo Medical School. MAIN MEASUREMENTS: Compared years of delay between the second and third years of medical school with third year clerkship grades, National Board of Medical Examiner’s (NBME) Subject Examinations, and United States Medical License Exam (USMLE) Step 2. MAIN RESULTS: 258, 13, and 31 students spent 0, 1, or > or = 3 years pursuing research between the second and third year. Baseline measures of knowledge before matriculation and before the third year were similar between groups. Whereas a 1-year delay had no significant effect, a > or = 3-year delay was associated with fewer clerkship honors and lower NBME Medicine, Pediatrics, and Psychiatry percentiles compared to no delay (all p or = 3-year delay had a 77% reduction in the odds of honors in Medicine. For each year of delay beyond 3, students’ third-year NBME Medicine, Neurology, Obstetrics and Gynecology, and Psychiatry scores decreased as did USMLE Step 2 scores (r = -.38 to -.50, p or = 3 years between the second and third years of medical school are associated with lower grades and scores on clinical knowledge tests. Further research is needed to determine the optimal timing of research training and develop effective interventions to facilitate reentry into the medical school curriculum.
PMID: 17492473 [PubMed - indexed for MEDLINE]
PMCID: PMC2305740 [Available on 08/01/08]
1: Acad Emerg Med. 2007 Mar;14(3):283-6. Epub 2007 Jan 22.Links
A more explicit grading scale decreases grade inflation in a clinical clerkship.Weaver CS, Humbert AJ, Besinger BR, Graber JA, Brizendine EJ.
Department of Emergency Medicine, University School of Medicine, Indianapolis, IN, USA. chsweave@iupui.edu
OBJECTIVES: The medical education literature contains few publications about the phenomenon of grade inflation. The authors’ clinical clerkship grading scale suffered from apparent inflation relative to the recommended university distribution. The investigators hypothesized that a simple change of the shift grading cards, using explicit criteria, would decrease this grade inflation and aid to redistribute the shift evaluations. METHODS: This was a before-and-after study examining medical student shift evaluation grades. Evaluators and students were blinded to the purpose of the card change and were unaware that a study was being conducted. Beginning June 1, 2005, the authors altered the shift evaluation cards from the previous four choices of honors, high pass, pass, or fail to five choices of upper 5%, upper 25%, expected, below expected, or far below expected, and explicit grading criteria were provided. No other interventions to alter the grade distribution occurred. Data were collected on all evaluations from June 1, 2004, to March 31, 2005 (before change), and compared with data on all evaluations from June 1, 2005, to March 31, 2006 (after change). RESULTS: A total of 3,349 evaluations were analyzed: 1,612 before the card change and 1,737 after the change. The grade distribution before the card change was as follows: honors, 22.6%; high pass, 49.0%; pass, 28.4%; and fail, 0%. This compared with the following ratings after the card change: upper 5%, 9.8%; upper 25%, 41.2%; expected, 46.2%; below expected, 2.8%; and far below expected, 0% (p < 0.001). CONCLUSIONS: A simple change in shift evaluation cards to include more explicit grading criteria resulted in a significant change in grade distribution and greatly decreased grade inflation.
PMID: 17242385 [PubMed - indexed for MEDLINE]
1: Clin Orthop Relat Res. 2006 Aug;449:50-5. Links
A quantitative composite scoring tool for orthopaedic residency screening and selection.Turner NS, Shaughnessy WJ, Berg EJ, Larson DR, Hanssen AD.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
The ability to accurately screen and select orthopaedic resident applicants with eventual successful outcomes has been historically difficult. Many preresidency selection variables are subjective in nature and a more standardized objective scoring method seems desirable. A quantitative composite scoring tool (QCST) to be used in a standardized manner to help predict orthopaedic residency performance from application materials was developed. In 64 orthopaedic residents, four predictors (United States Medical Licensing Examination [USMLE] Part I scores, Alpha Omega Alpha status, junior year clinical clerkship honors grades, and the QCST score) were analyzed with respect to four residency outcomes assessments. The outcomes included three standardized assessments, the orthopaedic in-training examination scores (OITE), the American Board of Orthopaedic Surgery (ABOS) written and oral examinations, and an internal outcomes assessment, attainment of satisfactory chief resident associate (CRA) status. Collectively, the QCST score had the strongest association as a predictor for all three standardized outcomes assessments (p < 0.001). Honors grades during junior years clinical clerkships was most strongly associated with satisfactory CRA status (p < 0.001). A composite scoring tool that is an effective predictor of orthopaedic resident outcomes can be developed. Additional work is still required to refine this scoring tool for orthopaedic residency screening and selection.
PMID: 16735881 [PubMed - indexed for MEDLINE]