Variation in medical student grading criteria: a survey of clerkships in obstetrics and gynecology

doi:10.1016/j.ajog.2003.12.020

American Journal of Obstetrics and Gynecology

Volume 190, Issue 5, May 2004, Pages 1388-1393

https://doi.org/10.1016/j.ajog.2003.12.020 Get rights and content

Abstract

Objective

Our purpose was to assess how obstetrics/gynecology clerkships incorporate methods of student assessment into grades.

Study design

A survey that included a broad range of assessment methods was distributed to obstetrics/gynecology clerkship directors registered with the Association of Professors of Gynecology and Obstetrics. Respondents were asked to indicate the methods used for assessment and to indicate the weight assigned to these methods in determining a student grade.

Results

Of the 146 surveys distributed, there were 53 respondents (36.4%). The most common methods of subjective assessment included evaluation of patient presentation skills and performance on ward rounds. The 2 most commonly used objective methods, general assessment of cognitive knowledge and the National Board of Medical Examiners Subject Examination in Obstetrics and Gynecology, generally accounted for 75% of the final grade, although these same 2 components also had the widest range of assigned weights reported.

Conclusion

Assessment methods and incorporation into a final grade vary widely across obstetrics/gynecology clerkships.

Section snippets

Materials and methods

A survey was developed to examine methods of medical student assessment in obstetrics and gynecology and the weights assigned to these assessment methods in calculating final student grades. The methods of student assessment included in this survey incorporated a broad range of potential evaluation tools compiled from review of the ACGME toolbox of assessment methods, some of the techniques described in the previously cited references, and processes used at our institution.5., 6., 7., 8., 9.,

Results

The survey was distributed through APGO to 146 obstetrics/gynecology clerkship directors. There were 53 respondents who returned the survey, for an overall response rate of 36.4%. Of the 53 survey respondents, several provided partial responses or comments not specifically listed as survey options. All responses provided according to the survey format were included in the compilation of the data; additional comments or responses that were not options on the distributed survey were separately

Comment

The weight assigned to various methods of student assessment in the calculation of an actual grade has not been commonly reported in medical education literature. A literature search of the PubMed database of the United States National Library of Medicine, using the search terms “medical student assessment,” “medical student grade,” “medical student scores,” “medical student evaluation,” and “medical student performance,” identified few studies in which the actual weight of components used for

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Current practices and perspectives on clerkship grading in obstetrics and gynecology
2024, American Journal of Obstetrics and Gynecology
Clerkship grades in obstetrics and gynecology play an increasingly important role in the competitive application process to residency programs. An analysis of clerkship grading practices has not been queried in the past 2 decades in our specialty.
This study aimed to investigate obstetrics and gynecology clerkship directors’ practices and perspectives in grading.
A 12-item electronic survey was developed and distributed to clerkship directors with active memberships in the Association of Professors of Gynecology and Obstetrics.
A total of 174 of 236 clerkship directors responded to the survey (a response rate of 73.7%). Respondents reported various grading systems with the fewest (20/173 [11.6%]) using a 2-tiered or pass or fail system and the most (72/173 [41.6%]) using a 4-tiered system. Nearly one-third of clerkship directors (57/163 [35.0%]) used a National Board of Medical Examiners subject examination score threshold to achieve the highest grade. Approximately 45 of 151 clerkship directors (30.0%) had grading committees. Exactly half of the clerkship directors (87/174 [50.0%]) reported requiring unconscious bias training for faculty who assess students. In addition, some responded that students from groups underrepresented in medicine (50/173 [28.9%]) and introverted students (105/173 [60.7%]) received lower evaluations. Finally, 65 of 173 clerkship directors (37.6%) agreed that grades should be pass or fail.
Considerable heterogeneity exists in obstetrics and gynecology clerkship directors’ practices and perspectives in grading. Strategies to mitigate inequities and improve the reliability of grading include the elimination of a subject examination score threshold to achieve the highest grade and the implementation of both unconscious bias training and grading committees.
To the point: medical education review of the RIME method for the evaluation of medical student clinical performance
2007, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In a survey of clerkship directors on grading of rotation components, the mean percentage weight that is given to the cognitive part of the obstetrics–gynecology clerkship grade was 45%. Seventy-four percent of programs used a variety of subjective methods of student assessment that typically accounted for a large component of the descriptive clinical grade.5,6 Reviews document the numerous pitfalls that are associated with obtaining accurate and helpful “subjective” performance evaluations of learners.7,8
This article, the sixth in the ongoing To The Point Series produced by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, reviews the Reporter-Interpreter-Manager-Educator (RIME) method for the evaluation of student clinical performance on the obstetrics and gynecology rotation. This article discusses the inherent challenges of descriptive narrative evaluation and the superiority of the RIME method in producing meaningful evaluation of and feedback for students. The use of the method to fulfill Liaison Committee on Medical Education standards and implementation of the method are described.
Personality type and clinical evaluations in an obstetrics/gynecology medical student clerkship
2005, American Journal of Obstetrics and Gynecology
The purpose of this study was to determine whether the Myers-Briggs type inventory extraversion is associated with clinical evaluation ratings that students earn during their (obstetrics/gynecology) junior medical student clerkship.
The Myers-Briggs type inventory was administered to medical students during their obstetrics/gynec clerkship. Bivariate correlations between clinical evaluations, National Board of Medical Examiners subject scores, and data from the Myers-Briggs type inventory extraversion scale were analyzed.
Pearson product-moment correlation between clinical and National Board of Medical Examiners subject scores was not significant (r = .25; P = .05). The National Board of Medical Examiners did not show significant correlations with the Myers-Briggs type inventory extraversion data. The clinical evaluations showed a significant correlation (r = .35; P = .005) with Myers-Briggs type inventory extraversion.
Results show that Myers-Briggs type inventory extraversion is correlated positively with clinical evaluations. The National Board of Medical Examiners subject examination and clinical evaluations were not correlated significantly. Findings question whether clinical evaluation data should be included in the obstetrics/gynecology medical student evaluation process.
Creating an ideal objective structured clinical exam for an obstetrics and gynecology medical student clerkship
2005, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In a 1999 Liaison Committee on Medical Education survey summarizing data from medical schools undergoing reaccreditation during 1993 to 1999, only 17.7% of schools were using an OSCE in the obstetrics and gynecology clerkship.5 A survey of obstetrics and gynecology clerkships by our institution in 2002 demonstrated that 33% of the respondents reported using a formal OSCE and an additional 20% reported using some form of graded skills exam, although not in an OSCE format.6 Therefore, although the use of an OSCE has increased, fewer than half of medical schools use a formal OSCE in an obstetrics and gynecology clerkship, despite the importance of assessing basic clinical skills.
The objective of the study was to describe our experience with the Objective Structured Clinical Exam during the third-year obstetrics/gynecology clerkship.
Our 8-station Objective Structured Clinical Exam is described in detail. We analyzed grades from the Objective Structured Clinical Exam for overall distribution, comparing among and between groups by year and among exam sites and correlating with the National Board of Medical Examiners subject exam and the final clerkship grades.
The Objective Structured Clinical Exam is provided at 3 sites, 1 at a technically advanced simulation center. Most students (54.6%) received a grade of A; however, the mean grade from the Objective Structured Clinical Exam at the simulation center (3.41 on a 4-point grade-point average scale) was lower than that at the clinic sites (3.60, P = .005; 3.73, P < .001). Effect of rotation order was identified only in the first year. Grades from the Objective Structured Clinical Exam were positively but weakly correlated with National Board of Medical Examiners subject exam and final clerkship grades.
An Objective Structured Clinical Exam in the obstetrics/gynecology clerkship can be administered with limited resources and provides a valuable assessment method.
The State of the Clerkship: A Survey of Emergency Medicine Clerkship Directors
2007, Academic Emergency Medicine
Citation Excerpt :
Other core medical specialties incorporate a written examination, most often the National Board of Medical Examiners subject examination, into their evaluation process. In these disciplines, the percent of clerkships incorporating this method of evaluation ranges from 65% to 89%.20–23 The mean percent contribution to the final rotation grade reported by clerkship directors in these specialties ranges from 24% to 31%.
An emergency medicine (EM) clerkship can provide a medical student with a unique educational experience. The authors sought to describe the current experiential curriculum of the EM clerkship, along with methods of evaluation, feedback, and grading.
A descriptive survey was utilized. Clerkship directors at EM residency programs accredited by the Accreditation Council for Graduate Medical Education completed an online questionnaire. Data were analyzed using descriptive statistics.
Ninety-two (70%) of 132 EM clerkship directors completed the survey. Sixty institutions (65%) accepted only fourth-year medical students, and 35% accepted both third- and fourth-year students. The median number of didactic lecture hours provided during each rotation block for students was ten (interquartile range [IQR], 6–16). The average length of a student's clinical shift was eight hours, while the median number of clinical shifts reported per rotation was 15 (IQR, 14–16). The median number of hours worked weekly by a medical student was 40 (IQR, 35–43). Fifty-four EM clerkship directors (59%) incorporated the Accreditation Council for Graduate Medical Education six core competencies into their evaluation process. Seventy-one clerkship directors (77%) used a shift evaluation card to evaluate the clinical performance of medical students. Fifty-four (59%) incorporated an end-of-rotation written examination to determine the final rotation grade for a medical student.
Medical students are exposed to a variety of didactic lectures and procedure labs but have similar experiences regarding shift length and work hours. Methods of evaluation of clinical performance vary across clinical sites.
Which Student Characteristics Are Most Important in Determining Clinical Honors in Clerkships? A Teaching Ward Attending Perspective
2019, Academic Medicine

View all citing articles on Scopus

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This information was presented in part during a workshop at the 2003 Association of Professors of Gynecology and Obstetrics (APGO) Faculty Development Seminar, January 2003, Maui, Hawaii.

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EducationVariation in medical student grading criteria: a survey of clerkships in obstetrics and gynecology☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Materials and methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Surg

Am J Surg

Am J Surg

Am J Obstet Gynecol

Am J Obstet Gynecol

Ambul Pediatr

Women's health care competencies sample learning objectives for undergraduate medical education

Student assessment

Acad Med

Competency-based student self-assessment on a surgery rotation

J Surg Res

Education
Variation in medical student grading criteria: a survey of clerkships in obstetrics and gynecology☆