Surgical EducationThe use of an essay examination in evaluating medical students during the surgical clerkship
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.
References (24)
- et al.
How can we test clinical reasoning?
Lancet
(1995) - et al.
Validity and reliability of a novel written examination to assess knowledge and clinical decision making skills of medical students on the sugery clerkship
Am J Surg
(2014) - et al.
Faculty and resident evaluations of medical students on a surgery clerkship correlate poorly with standardized exam scores
Am J Surg
(2014) 2008 Clinical Clerkship Directors Survey Results
(2008)The assessment of professional competence: developments, research and practical implications
Adv Health Sci Educ
(1996)Educational assessment: expanded expectations and challenges
Educ Eval Policy Anal
(1993)Beyond multiple-choice questions and essays. The need for a new way to assess clinical competence
Acad Med
(1993)- et al.
A closer look at cueing effects in multiple-choice questions
Med Educ
(1996) - et al.
A comparison of multiple-choice tests and free-response tests in examinations of clinical competence
Med Educ
(1979) - et al.
A New Approach to Assessing Clinical Problem Solving Skills by Written Examination Conceptual Basis and Initial Pilot Test Results. Teaching and Assessing Clinical Competence
(1990)
Different written assessment methods: what can be said about their strengths and weaknesses?
Med Educ
Free-response formats for evaluating clinical judgment
Acad Med
Cited by (0)
This study was funded by the Department of General Surgery, Rush University Medical Center.