Grade Inflation in the Internal Medicine Clerkship: A National Survey

Fazio, Sara B.; Papp, Klara K.; Torre, Dario; DeFer, Thomas M.

doi:10.1080/10401334.2012.741541

Cited by 57 publications

(48 citation statements)

References 19 publications

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“…This failure rate is similar to clerkship failure rates reported previously. 3,20 Identifying these failing students is a complex task, made more difficult by the low frequency of this event.…”

Section: Discussionmentioning

confidence: 99%

“…2 However, one-third of these same clerkship directors acknowledge passing students who should have failed. 3 Clerkship directors cite poor documentation of areas of deficiency, concern about a possible appeal, and lack of remediation opportunities as reasons for passing students who may have otherwise failed. 4 Practicing physicians who have been disciplined by a medical board are twice as likely to have had performance issues during their clinical clerkships as physicians who have not been disciplined.…”

Section: Introductionmentioning

confidence: 99%

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Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

2016

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BACKGROUND: In addition to training future members of the profession, medical schools perform the critical role of identifying students who are failing to meet minimum standards in core competencies. OBJECTIVE: To better understand reasons for failure in an internal medicine clerkship. DESIGN: A qualitative content analysis of letters describing reasons for students' failure. PARTICIPANTS: Forty-three students (31 men) who failed the internal medicine clerkship at the University of Minnesota Medical School, 2002. APPROACH: We conducted a qualitative content analysis of the 43 letters describing reasons for students' failure. We coded critical deficiencies and mapped them to the Physician Competency Reference Set (PCRS) competency domains and classified them into two categories: conduct (unprofessional behaviors) and knowledge and skills specific to the practice of medicine. We then calculated the frequency of each critical deficiency. We statistically tested for relationships between gender and critical deficiencies in each of the competency domains. KEY RESULTS: We coded 50 critical deficiencies with all codes mapping to a PCRS competency domain. The most frequently cited deficiencies were Binsufficient knowledge( 79 % of students) and Binadequate patient presentation skills^(74 %). Students exhibited critical deficiencies in all eight competency domains, with the highest concentrations in Knowledge for Practice (98 %) and Interpersonal and Communication Skills (91 %). All students demonstrated deficiencies in multiple competencies, with 98 % having deficiencies in three or more. All 43 students demonstrated deficits in the knowledge and skills category, and 81 % had concurrent conduct issues. There were no statistically significant relationships between gender and critical deficiencies in any competency domain. CONCLUSIONS: This study highlights both the diversity and commonality of reasons that students fail a clinical clerkship. Knowing the range of areas where students struggle, as well as the most likely areas of difficulty, may aid faculty in identifying students who are failing and in developing remediation strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

2016

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“…[23][24][25][26][27] One of the primary driving forces behind the development of the SLOR was to limit "clerkship grade and adjective inflation," which was believed to be "rampant" at the time. 5,11 A recurrent theme throughout in the first SLOR Task Force study was that grade inflation is the primary limitation of the SLOR.…”

Section: Discussionmentioning

confidence: 99%

Council of Emergency Medicine Residency Directors' Standardized Letter of Recommendation: The Program Director's Perspective

Love

Smith

Weizberg

et al. 2014

Academic Emergency Medicine

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Objectives: The standardized letter of evaluation (SLOE) was created in 1997 to provide residency program directors (PDs) with a summative evaluation that incorporates normative grading (i.e., comparisons to peers applying to emergency medicine [EM] training). Although the standard letter of recommendation (SLOR) has become increasingly popular and important in decision-making, it has not been studied in the past 12 years. To assess the SLOR's effectiveness and limitations, the perspective of EM PDs was surveyed in this study.Methods: After validation of the questionnaire by 10 retired PDs, the survey was sent to the PD of each of the 159 EM residencies that existed at that time. The survey was circulated via the Council of Emergency Medicine Residency Directors' (CORD) listserv from January 24, 2013, to February 13, 2013. Weekly e-mail reminders to all PDs served to increase participation.Results: A total of 150 of 159 PDs (94.3%) completed the questionnaire. Nearly all respondents (149 of 150; 99.3%) agreed that the SLOR is an important evaluative tool and should continue to be used. In the application process, 91 of 150 (60.7%) programs require one or more SLORs, and an additional 55 (36.7%) recommend but do not require a SLOR to be considered for interview. When asked to identify the top three factors in deciding who should be interviewed, the SLOR was ranked first (139 of 150; 92.7%), with EM rotation grades ranked second (73 of 150; 48.7%). The factors that were most often identified as the top three that diminish the value of the SLOR in order were 1) "inflated evaluations" (121 of 146; 82.9%), 2) "inconsistency between comments and grades" (106 of 146; 72.6%), and 3) "inadequate perspective on candidate attributes in the written comments" and "inexperienced authors" (60 of 146; 41.1% each). Conclusions:The SLOR appears to be the most important tool in the EM PD's armamentarium for determining which candidates should be interviewed for residency training. Although valuable, the SLOR's potential utility is hampered by a number of factors, the most important of which is inflated evaluations. Focused changes in the SLOR template should be mindful that it appears, in general, to be successful in its intended purpose.ACADEMIC EMERGENCY MEDICINE 2014;21:680-687 © 2014 by the Society for Academic Emergency Medicine P rior studies have shown that traditional narrative letters of recommendation (NLOR) suffer from a number of significant limitations. Such letters do not predict future performance.1,2 They often repeat cognitive merits of the applicant and do not specifically address noncognitive domains that may be more predictive of performance as a resident. 2,3 The information that is provided is not comparative and is often

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“…8 Grade inflation is a tenacious problem for medical educators, due to leniency bias, halo effect, desire to reward well-liked trainees, and unpleasant message avoidance. [10][11][12] Fifty-five percent of internal medicine clerkship directors reported difficulty with grade inflation. 11 The standardized letter of recommendation for residency applicants to emergency medicine programs placed 40.1% of potential trainees in the top 10%.…”

Section: Discussionmentioning

confidence: 99%

Combating Grade Inflation in Nephrology Clinical Rotation Evaluations Using Faculty Education and a 5-Point Centered Rating Scale

Yuan

Nee

Abbott

et al. 2016

Journal of Graduate Medical Education

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Grade Inflation in the Internal Medicine Clerkship: A National Survey

Abstract: A majority of clerkship directors report that grade inflation still exists. In addition, many note students who passed despite the clerkship director believing they should have failed. Interventions should be developed to address both of these problems.

Cited by 57 publications

References 19 publications

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

Describing Failure in a Clinical Clerkship: Implications for Identification, Assessment and Remediation for Struggling Learners

Council of Emergency Medicine Residency Directors' Standardized Letter of Recommendation: The Program Director's Perspective

Combating Grade Inflation in Nephrology Clinical Rotation Evaluations Using Faculty Education and a 5-Point Centered Rating Scale

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