Reviewing Internal Medicine Clerkship Grading Through a Proequity Lens: Results of a National Survey

Lai, Cindy J.; Alexandraki, Irene; Ismail, Nadia; Levine, Diane; Onumah, Chavon; Pincavage, Amber T.; Jacob, Jackcy; Jenkins, Melissa O; Nagarur, Amulya; Kisielewski, Michael; Osman, Nora Y.

doi:10.1097/acm.0000000000005142

Cited by 2 publications

(4 citation statements)

References 43 publications

(69 reference statements)

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“…Grading committees and group decision-making are thought to promote grading consistency [6,18,19], especially when student data is reviewed in a de-identified manner. As evidenced by a recent survey of Clerkship Directors in Internal Medicine, many institutions are adopting grading committees as one strategy to improve grading equity [24]. Our study explores the opinions of faculty and resident assessors in the first year after transition to grading committees in the WUSM Internal Medicine clerkship.…”

Section: Discussionmentioning

confidence: 99%

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Frontline assessors’ opinions about grading committees in a medicine clerkship

Lewis,

Nolan,

Zickuhr

2024

BMC Med Educ

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Background Collective decision-making by grading committees has been proposed as a strategy to improve the fairness and consistency of grading and summative assessment compared to individual evaluations. In the 2020–2021 academic year, Washington University School of Medicine in St. Louis (WUSM) instituted grading committees in the assessment of third-year medical students on core clerkships, including the Internal Medicine clerkship. We explored how frontline assessors perceive the role of grading committees in the Internal Medicine core clerkship at WUSM and sought to identify challenges that could be addressed in assessor development initiatives. Methods We conducted four semi-structured focus group interviews with resident (n = 6) and faculty (n = 17) volunteers from inpatient and outpatient Internal Medicine clerkship rotations. Transcripts were analyzed using thematic analysis. Results Participants felt that the transition to a grading committee had benefits and drawbacks for both assessors and students. Grading committees were thought to improve grading fairness and reduce pressure on assessors. However, some participants perceived a loss of responsibility in students’ grading. Furthermore, assessors recognized persistent challenges in communicating students’ performance via assessment forms and misunderstandings about the new grading process. Interviewees identified a need for more training in formal assessment; however, there was no universally preferred training modality. Conclusions Frontline assessors view the switch from individual graders to a grading committee as beneficial due to a perceived reduction of bias and improvement in grading fairness; however, they report ongoing challenges in the utilization of assessment tools and incomplete understanding of the grading and assessment process.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, grading committee members are still subject to inequities in the integration and prioritization of assessment data. This highlights the ongoing importance of implicit bias training for assessors and grading committee members, a practice that has not yet been universally adopted among medical schools [24].…”

Section: Discussionmentioning

confidence: 99%

Frontline assessors’ opinions about grading committees in a medicine clerkship

Lewis,

Nolan,

Zickuhr

2024

BMC Med Educ

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“…Questions underwent multiple revisions and were pilot tested by experts in clinical CLEs to ensure general item validity and consistency. The writing group followed prior published guidelines to optimize question clarity and content 15,16 …”

Section: Methodsmentioning

confidence: 99%

“…The writing group followed prior published guidelines to optimize question clarity and content. 15,16 The final survey consisted of 18 questions (several with subparts), including multiple choice (single best answer and multiple response with write-in fields for "other"), Likert scale, numeric entry questions, and open-text essay questions. We included definitions for the terms bias event, microaggression, and macroaggression to clarify and standardize these concepts for survey respondents.…”

Section: Methodsmentioning

confidence: 99%

Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors

Henschen,

Pascoe,

Kisielewski

et al. 2023

Acad Med

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Purpose Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment. Method In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership. Results Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 4-1; range, 0-50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were “always” aware of the outcome of bias reports. Conclusions Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting.

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Reviewing Internal Medicine Clerkship Grading Through a Proequity Lens: Results of a National Survey

Cited by 2 publications

References 43 publications

Frontline assessors’ opinions about grading committees in a medicine clerkship

Frontline assessors’ opinions about grading committees in a medicine clerkship

Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors

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