Bringing clerkship grading back to the bedside

Ryan, Michael S.; Haley, Kellen; Helou, Marieka; Ryan, Mark; Rigby, Fidelma; Santen, Sally A.

doi:10.1111/tct.13325

Cited by 3 publications

(4 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although there has been a multitude of commentaries published in the US addressing the benefits and pitfalls of criterion-based grading, there has been only one published study to date that assessed outcomes after transitioning to this grading scheme. In a study by Ryan et al, 8 Virginia Commonwealth University enacted a 4-tiered (Honors, High Pass, Pass, and Fail) criterion-based grading model in which students were evaluated across 4 domains: “Patient Care,” “Professionalism,” Communication/teamwork,” and “Medical Knowledge.” Students achieved Honors if they were deemed competent in all domains, exemplary in the “Patient Care” domain, and exemplary in at least 1 other domain. With this scheme, compared to previous AYs, more students (40% vs. 15%) received a grade of Honors, while substantially fewer (20% vs. 50%) received a grade of Pass.…”

Section: Discussionmentioning

confidence: 99%

Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship

Abraham

2024

Journal of Medical Education and Curricular Development

View full text Add to dashboard Cite

OBJECTIVES To compare grades, National Board of Medical Examiners (NBME) Shelf Exam scores, and student satisfaction with the Obstetrics and Gynecology (OB/GYN) clerkship after transitioning from normative to criterion-based grading. METHODS Between July 2021 and July 2022, the Icahn School of Medicine at Mount Sinai (ISMMS) adhered to a normative grading scheme in which ∼60% of students achieved a grade of Honors, 30% achieved a grade of High Pass and 10% achieved a grade of Pass for the OB/GYN clerkship. In July 2022, ISMMS transitioned to a criterion-based scheme. In this scheme, 6 competencies were created. Criteria were determined for each competency, delineating achieving a score of “Pass” versus “Honors” for the specific objective. Students needed to meet the criteria for Honors for 4 out of 6 of the competencies in order to ultimately receive a grade of Honors for the clerkship. The number of students achieving Honors, NBME shelf exam scores, and student clerkship satisfaction ratings between the normative and criterion-based schemes were compared. RESULTS The number of students studying in academic year (AY) 2021–2022 and AY 2022–2023 were 134 and 137, respectively. A significantly lower percentage of students received Honors in AY 2021–2022 than in AY 2022–2023 (66% vs. 96%, P < .01). Mean exam scores were significantly higher for those receiving Honors in AY 2021–2022 than in AY 2022–2023 ( P < .05); scores for AY 2021–2022 and AY 2022–2023 were 78.9, 95% CI [77.6, 80.1] and 76.7, 95% CI [75.6, 77.8], respectively. Mean exam scores for all students were not significantly different between the 2 academic cohorts (77.8 vs. 76.2, P = .06). Clerkship satisfaction rating was significantly higher in AY 2022–2023 than in AY 2021–2022 (4.1 vs. 3.7, P < .05). CONCLUSIONS These findings support a paradigm that compares learner performance to predefined measures as opposed to peer performance.

show abstract

Section: Discussionmentioning

confidence: 99%

Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship

Abraham

2024

Journal of Medical Education and Curricular Development

View full text Add to dashboard Cite

show abstract

“…The movement toward CBME has resulted in a significant shift toward criterion-based assessment approaches in U.S. medical schools. Examples include: clerkship leaders adopting criterion-based approaches to grading, 9,10 publication and implementation of entrustable professional activities, 20,21 and elimination of a numerical score for United States Medical Licensing Examination (USMLE) Step 1. 11 However, there is evidence that a criterion-based approach may represent the ideal rather than current state of assessment practice.…”

Section: Two Sides Of the Assessment Coin: Norm- Vs Criterion-referen...mentioning

confidence: 99%

“…1–6 With the emergence of CBME in medical schools, 6–8 institutions, educational leaders, and national organizations have increasingly adopted a criterion-based approach to grading and assessment. 9–11 However, there remains an implicit, and at times, explicit 12,13 demand for norm-referencing, especially at the juncture of medical school and residency training where peer comparison is critical to stratify applicants for residency selection. As a consequence, CBME is perpetually engaged in a metaphorical tug-of-war with norm-referencing.…”

mentioning

confidence: 99%

Competency-Based Medical Education in a Norm-Referenced World: A Root Cause Analysis of Challenges to the Competency-Based Paradigm in Medical School

Ryan¹,

Lomis²,

Deiorio³

et al. 2023

Academic Medicine

Self Cite

View full text Add to dashboard Cite

Competency-based medical education (CBME) requires a criterion-referenced approach to assessment. However, despite best efforts to advance CBME, there remains an implicit, and at times, explicit, demand for norm-referencing, particularly at the junction of undergraduate medical education (UME) and graduate medical education (GME). In this manuscript, the authors perform a root cause analysis to determine the underlying reasons for continued norm-referencing in the context of the movement toward CBME. The root cause analysis consisted of 2 processes: (1) identification of potential causes and effects organized into a fishbone diagram and (2) identification of the 5 whys. The fishbone diagram identified 2 primary drivers: the false notion that measures such as grades are truly objective and the importance of different incentives for different key constituents. From these drivers, the importance of norm-referencing for residency selection was identified as a critical component. Exploration of the 5 whys further detailed the reasons for continuation of norm-referenced grading to facilitate selection, including the need for efficient screening in residency selection, dependence upon rank-order lists, perception that there is a best outcome to the match, lack of trust between residency programs and medical schools, and inadequate resources to support progression of trainees. Based on these findings, the authors argue that the implied purpose of assessment in UME is primarily stratification for residency selection. Because stratification requires comparison, a norm-referenced approach is needed. To advance CBME, the authors recommend reconsideration of the approach to assessment in UME to maintain the purpose of selection while also advancing the purpose of rendering a competency decision. Changing the approach will require a collaboration between national organizations, accrediting bodies, GME programs, UME programs, students, and patients/societies. Details are provided regarding the specific approaches required of each key constituent group.

show abstract

“…Throughout the 20th century, amidst rapidly developing technological advances, medical schools and educators increasingly focused their teaching on the acquisition of scientific knowledge [ 1–3 ]. With this shift, medical learners moved further away from the bedside, become more specialized and isolated, and experienced unprecedented rates of burnout [ 4–6 ]. The integration of the arts and humanities – historically seen as fundamental to the practice of medicine – into medical education has been proposed as a solution to these problems.…”

Section: Introductionmentioning

confidence: 99%

Understanding the role of the art museum in teaching clinical-level medical students

Kagan

Kelly-Hedrick

Benskin

et al. 2021

Medical Education Online

View full text Add to dashboard Cite

Introduction. The role of the visual arts in medical education has been understudied, especially with regard to program evaluation and learner assessment of complex competencies such as professional identity, team building, and tolerance for ambiguity. We designed a study to explore how an integrative art museum-based program might benefit 3rd and 4th year medical students. Methods. We piloted 6 sessions with 18 participants. Evaluation methods included post-session surveys and semi-structured focus groups, which we qualitatively analyzed using an open-coding method. Results. Seven themes emerged from the analysis related to the overarching realms of ‘form’ and ‘function.’ ‘Form’ themes included structural elements of the sessions that enabled engagement: (1) group format, (2) methods (e.g., discussion prompts, activities), (3) setting (e.g., physical space of the museum, temporal space), and (4) objects (e.g., paintings, sculptures). ‘Function’ themes included the personal and professional value and meaning derived from the sessions: (1) appreciation of others, (2) critical skills, and (3) personal inquiry. Discussion. Our results expand what is known about the role of the visual arts in medical education by suggesting that the visual arts may facilitate clinically relevant learning across a range of competencies via specific formal aspects (group format, method, setting, objects) of art museum-based pedagogical methods.

show abstract

Bringing clerkship grading back to the bedside

Cited by 3 publications

References 8 publications

Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship

Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship

Competency-Based Medical Education in a Norm-Referenced World: A Root Cause Analysis of Challenges to the Competency-Based Paradigm in Medical School

Understanding the role of the art museum in teaching clinical-level medical students

Contact Info

Product

Resources

About