Surgical Education
The use of an essay examination in evaluating medical students during the surgical clerkship

https://doi.org/10.1016/j.amjsurg.2015.03.035Get rights and content

Highlights

  • Poor standardized test takers may prefer open-ended forums to display knowledge.

  • We examined surgical clerkship grades of 781 consecutive 3rd year medical students.

  • We analyzed the impact an essay examination had on final surgical clerkship grades.

  • The essay exam increased the final clerkship grades in most letter grade categories.

  • The essay exam was found to positively correlate with the NBME shelf exam.

Abstract

Background

Third-year medical students are graded according to subjective performance evaluations and standardized tests written by the National Board of Medical Examiners (NBME). Many “poor” standardized test takers believe the heavily weighted NBME does not evaluate their true fund of knowledge and would prefer a more open-ended forum to display their individualized learning experiences. Our study examined the use of an essay examination as part of the surgical clerkship evaluation.

Methods

We retrospectively examined the final surgical clerkship grades of 781 consecutive medical students enrolled in a large urban academic medical center from 2005 to 2011. We examined final grades with and without the inclusion of the essay examination for all students using a paired t test and then sought any relationship between the essay and NBME using Pearson correlations.

Results

Final average with and without the essay examination was 72.2% vs 71.3% (P < .001), with the essay examination increasing average scores by .4, 1.8, and 2.5 for those receiving high pass, pass, and fail, respectively. The essay decreased the average score for those earning an honors by .4. Essay scores were found to overall positively correlate with the NBME (r = .32, P < .001).

Conclusions

The inclusion of an essay examination as part of the third-year surgical core clerkship final did increase the final grade a modest degree, especially for those with lower scores who may identify themselves as “poor” standardized test takers. A more open-ended forum may allow these students an opportunity to overcome this deficiency and reveal their true fund of surgical knowledge.

Section snippets

Methods

We retrospectively examined the final surgical clerkship grades of 781 consecutive medical students enrolled in a large urban academic medical center from 2005 to 2011. Their final clerkship score was based on subjective clinical evaluations, the NBME examination, a professionalism evaluation, performance of basic surgical skills, a graded history and physical (H&P) and an essay examination. Students were assigned one of four nominal final clerkship grades including honors (H), high pass (HP),

Results

Overall 781 consecutive students' scores were evaluated. Average student age was 27.2 years with a slight majority (51.2%) being female. Ultimately, only 119 (15.2%) matched into a surgical specialty, with 58 (7.4%) enrolling in a general surgery residency.

Students received a final grade of H (22%), HP (30.3%), P (46.9%), or F (.7%). Average scores for the individual components of the final grade consisted of the clinical evaluation (69.6%), NBME examination (55%), essay examination (85.7%),

Discussion

Our university uses the essay and NBME subject examinations as metrics in evaluating the objective medical knowledge of a student during their surgery clerkship. Comparison of final grades with and without the essay examination demonstrated a modest increase when the essay examinations were included. The largest increase was seen in students with lower letter grades who may identify themselves as “poor” standardized test takers. Therefore these “poor” standardized test takers may be better at

Conclusion

Clerkship directors should consider adding alternative methods in gauging objective medical knowledge such as open-ended essay examinations in their grading schema. In addition, if essay examinations currently exist in the program and have little weight on the final grade, then consideration should be made to increase their weight to allow students who consider themselves “poor” standardized test takers other means to exhibit their true fund of medical knowledge.

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  • Cited by (0)

    This study was funded by the Department of General Surgery, Rush University Medical Center.

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