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.

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. 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: We operate under the assumption you are professional. This is best confirmed 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. We use the 4 questions common across all clerkships assessing for respect, honesty, work ethic, and striving for excellence. These 4 items were designed to pick up concerns rather than discriminate degrees of professionalism. If we see a pattern of concerns this could lower your evaluation by half a letter grade. If something very egregious is reported and confirmed (e.g. cheating) this could lead to a needs remediation in professionalism and not passing the clerkship. Very serious professionalism concerns will be reported to the Academic Status Committee.

Patient Care (35%): 20% is from ward evaluations using the 9 point scale and 15% is from the 4 H&P submissions.

Please note patient write-ups 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.)

Medical Knowledge (20%): Fund of knowledge is assessed by the NBME subject exam (15%) and evaluations by your team (5%). The subject exam scores are converted to the 9 point scale using the following conversion which is based on national percentiles. There is not a minimum exam pass score for the clerkship. However, students who score below the 10th percentile nationally (63) need to meet with the clerkship director to discuss whether a test taking remediation plan should be developed to promote improved performance on subsequent NBME exams including Step 2 CK.

>/=86 = 9.0 (~ top 10% nationally)

85-54:  0.25 points are subtracted for each point below 86. For example, an 85 equates to 8.75.

</= 54 = 1.0 (~ bottom 1% nationally)

Human Communication (25%): 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. Team evaluations of your charting (5%) and oral presentations (10%) make up 15% of this competency.

Practiced-based Learning (10%): This is evaluated by your teams using the 9 point scale. You will also review the required SMARTER goals during your mid clerkship feedback session and summaries of formative feedback will be submitted at the end of the clerkship.

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. 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 5-5.99
<5=Needs Remediation