Evaluation of students in medicine clerkships

Abstract

This article reports the results of a survey of the 124 medical schools in the United States and Puerto Rico, mailed in late 1986; the majority of the responses from 101 schools were received in early 1987. The authors report their findings concerning the overall process used by these schools to evaluate medicine clerks, specifically identifying the importance given to subjective evaluations, made by attending physicians and/or housestaff, compared with the importance given to clerks' performances on objective means of evaluation based on written and/or oral examinations, whether national or faculty-developed. The study reveals that the subjective evaluations of clerks by faculty attending physicians and by housestaff working with the clerks were used by 98 and 83 of the responding schools, respectively, and were given the greatest evaluative weight. Examinations of all types were used by 87 of the responding schools. The National Board of Medical Examiners (NBME) Part II Medicine Examination was the most frequently used and heavily weighted examination, followed by written faculty examinations. Oral examinations were the least frequently used evaluative tools, carried the least weight, and were rarely used without another examination. In light of their findings, the authors maintain that further research should be done to clarify whether the NBME Part II Medicine Examination is an appropriate instrument to measure the knowledge acquired during clerkship experiences.

SPECIAL ARTICLE: Cognitive, Social and Environmental Sources of Bias in Clinical Performance Ratings

“…In clerkships using descriptor grades (e.g., honors, high pass, pass, fail), 46% of the students received ratings in the top two performance categories. Because 86% of the internal medicine clerkships incorporated results of an objective knowledge test such as the National Board of Medical Examiners (NBME) internal medicine subject test into student grades, 73 it is reasonable to expect that percentages in the top two grading categories would be higher if clinical ratings alone were used for grading. Objective test results generally lower grades.…”

Sources of variability in medical student evaluations on the internal medicine clinical rotation

“…1 In their clinical years, medical students' final grades in their rotations are often calculated using standardized surveys. 1,2 These surveys typically rate students on various competencies using a Likert or semantic differential scale, which is completed by faculty and residents.…”

“…1 In their clinical years, medical students' final grades in their rotations are often calculated using standardized surveys. 1,2 These surveys typically rate students on various competencies using a Likert or semantic differential scale, which is completed by faculty and residents. 1,2 While there has been a move towards more standardized ways of evaluating students, these clinical evaluations are still largely based on non-standardized subjective interactions.…”

“…1,2 These surveys typically rate students on various competencies using a Likert or semantic differential scale, which is completed by faculty and residents. 1,2 While there has been a move towards more standardized ways of evaluating students, these clinical evaluations are still largely based on non-standardized subjective interactions. 2 As each student is only exposed to a small subset of all possible raters, differences in raters' grading could introduce variability into the measurement of a student's performance and thus make the measurement less reliable.…”

“…Additionally, specific attributes of the student, evaluator, or environment in which the interaction took place might affect the student's scores by introducing systematic differences into the measurement, further decreasing the reliability of the system. While previous research has studied the relationships between various demographic data of those being evaluated and their numerical scores 1,[3][4][5][6][7][8][9][10][11] as well as the reliability of clinical Correspondence: Ryan Spielvogel, 4860 Y Street, Suite 1600, Sacramento, CA 95817, USA Email: Ryan.Spielvogel@gmail.com evaluations, 4 few have investigated the effect these have on the system's overall reliability or further explored the specific sources of the variation. Additionally, many studies on this topic examined evaluations of residents by faculty.…”