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 submission of write-ups. You will also submit goals and have the opportunity to share optional supporting documentation of how you met your goals and/or improved your performance. 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 IM coach and teamlet, 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 H&P submissions.

Please note patient write-ups (clinical reasoning) 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.) We evaluate the 4 write-ups you select as representing your best work using the IDEA evaluation tool that you used for peer feedback. There is a second page that you do not use for peer feedback that turns the evaluation into a score using a 9 point scale. (You can view this form under the “write-up summative assessment” link. We average the score of the 4 write-ups to generate a score from 1-9, which is 50% of the patient care score and your team evaluation average score is the other 50% of the patient care score.

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 6/20/17 to reflect changes in how the NBME sets its scores.

>85    = 9.0 (~top 10% nationally)
82-85 = 8.0 (~top 20% nationally)
78-81 = 7.0 (~top 33% nationally)
74-77 = 6.0 (78 is the historic UFCOM mean)
67-73 = 5.0 (~50% nationally)
62-66 = 4.0 (below 20% nationally)
<62 = 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. This is optional. Eight or more patient evaluations will be averaged in with your team evaluations of your patient communication skills (10% of this competency). Specifically if you have at least 8 patient evaluations with an average rating of 4.7 or higher, we will treat that as a score of 9 for 50% of your patient communication skills score and the team evaluation will be the other 50% of that score. If the patient evaluation average is 4.2-4.6, we will average in an 8 (only if this helps you). We have never had a student’s patient evaluation average lower than this and would not factor it into your score.

Practiced-based Learning (~15%): This is evaluated by your teams using the 9 point scale. You will also submit the required SMARTER goals and summaries of formative feedback. We recognize many things you do to improve your own practice may go unseen. We have outlined optional ways you can demonstrate your practice of EBM and other self-directed learning. Any of these optional submissions will be considered when determining your final PBLI score.

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. Additionally, you are required to submit a post-discharge phone call log and complete HVC modules 1 and 5. Any additional work you do in HVC, patient safety, interprofessional collaboration, or patient advocacy is optional but, it will be considered when determining your final SBP score.

The final grade is determined by generating a score from 1-9 for each competency as described above. 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