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How Grades Are Determined

Grades

During this clerkship you will be evaluated in all of the six core competencies of the college of medicine. As you know, the competencies are highly interrelated and therefore the way we divide some of the behaviors is somewhat arbitrary. But when viewed as a whole, the six competencies do cover all the major qualities we want to assess in your development as a physician. There are multiple ways we can assess your performance on this clerkship. No one evaluation is weighted the same for each competency.

On the medicine clerkship we assess you using a standard MCQ NBME subject exam, evaluations by your teams (faculty, residents, and interns), and submissions to a portfolio that you will create. Each of these methods of assessment works well for some competencies and not as well for others. The following is a breakdown by competency of how the evaluations are approximately weighted.

Professionalism (~10%): This is best assessed by your teams so the ward evaluations are the primary method of assessment. However, the way you interact with staff, your portfolio advisor, and your ability to follow directions also are taken into account. This is the only aspect of your evaluation that does not use the 9 point scale directly but rather there are four questions with 3 descriptive anchors each. We label the “best” descriptive anchor as a 3, the “good/no problem” as 2, and the “area of concern” as a 1. Assuming 12 is the best possible rating and 4 the worst, the following is how we approximately convert your team evaluations to the 9 point scale:

9   (11.5-12)
8   (11-11.49)
7   (10.5-10.99)
6   (9.5-10.49)
5   (8.5-9.49)
4   (7.5-8.49)
3   (6.5-7.49)
2   (5.5-6.49)
1  <5.5

This conversion is approximate because a “2” rating in some questions is subjectively better than others and we take that into account.

Patient Care (~30%): This is very much a combination of ward evaluations using the 9 point scale and portfolio submissions. Students tend to need the most help with physical exam skills and clinical reasoning and medical decision making. There are ways to provide clear evidence in the portfolio of your achievement in these areas (e.g. mini-CEX, write-ups, evaluations of observed physical examinations).

Please note patient write-ups (clinical reasoning) are weighted ~ 15% of this competency are looked at very closely, particularly in terms of how you prioritize and organize problems into a problem representation, develop a differential diagnosis and subsequent working diagnosis. (Doc-in-the-Box sessions can really help you learn to do this if it is a weak area.)

Medical Knowledge (~15%): Fund of knowledge is assessed by the NBME subject exam. The scores are converted to the 9 point scale using the following conversion which is based on national percentiles: These cutoffs have been updated as of 9/1/15 to reflect changes in how the NBME sets its scores.

>83 = 9.0 (~top 10% nationally)
81-83 = 8.0 (~top 20% nationally)
77-80 = 7.0 (~top 33% nationally)
73-76 = 6.0 (78 is the historic UFCOM mean)
65-72 = 5.0 (~50% nationally)
61-64 = 4.0 (below 20% nationally)
<61 = maximum 3.0 (~ below 10% nationally and exam failure that needs remediation- if this is the only deficit in your clerkship performance, then successfully passing a retake of the exam is the only required remediation and an “H” (hold) grade will be assigned until that time. The exam may be retaken with another rotation group or on the official retake day for the College of Medicine in June. Students who pass the exam may not retake it for a grade change.)

Human Communication (~20%): This relates to your interaction with patients and your ability to communicate effectively with other team members in the form of oral presentations and daily progress notes. It is evaluated by your teams using the 9 point scale. You also have the opportunity to ask patients to directly evaluate you and this may be included optionally in your portfolio. Eight or more patient evaluations may take precedence over team evaluations of your patient communication skills (10% of this competency), particularly when there is a discrepancy between the two. You also may optionally submit examples of progress notes and mini-CEX evaluations of your oral presentations in the portfolio.

Practiced-based Learning (~15%): This is evaluated by your teams using the 9 point scale. But we recognize that many things you do to improve your own practice may go unseen. The portfolio gives you the opportunity to demonstrate this and for students who chose to focus on this aspect of the portfolio it is weighted more heavily than the team evaluations.

System-based Practice (~10%): This is evaluated both by your ward team as it related to your ability to function as part of a team using the 9 point scale. But all the other aspects of this competency can be demonstrated in the portfolio.

“The Portfolio Factor”: We first look to see if your teams’ evaluations align with the work you submitted in your portfolio. If so, the numeric evaluation stands. If not, we adjust up or down no more than one point. (Historically the only area that potentially is adjusted down is the patient care competency if the write-ups do not convey the same level of completeness and thoughtfulness than the team rating does.) Optionally submissions can only potentially help. But, you do not need to make optional submissions in order to earn an A. (If your team evaluations are already 8s and 9s, optional submissions are unlikely to affect the final grade.) However, optional submission can make a significant difference when evaluations are in the 6-7 range and the submissions are of high quality.

The final grade is determined by generating a score from 1-9 that includes any adjustments based on the portfolio for each competency. These scores are then weighted according to the percent weights noted above for each competency. Those weighted scores are added together to get a final numeric score that is assigned a grade using the following scale:

A >/= 8
B+ 7.41-7.99
B 6.61-7.40
C+ 6.0- 6.6
C 5-6
<5=Needs Remediation