Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias

Onumah, Chavon; Lai, Cindy J.; Levine, Diane; Ismail, Nadia; Pincavage, Amber T.; Osman, Nora Y.

doi:10.1016/j.amjmed.2021.06.001

Cited by 14 publications

(24 citation statements)

References 52 publications

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“…26 Thus, medical education leaders are heeding calls to critically examine the learning environment through a proequity lens using educational equity as a core principle. 22,[27][28][29] Clinician-educators, particularly those in educational leadership roles, must act as stewards and allies for multiple constituencies in the learning and working environment. [30][31][32][33] Students from URiM groups face inequities in education just as patients from underserved racial and ethnic communities face inequities in health care.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the individual and structural biases inherent to current assessment methods, most LCME-accredited medical schools continue to rely on individual clinical performance evaluations and standardized tests as the foundation of clerkship assessment. 34 Core clerkship leaders have begun to recognize the compelling need to modify assessment methods and implement proequity strategies, 12,29,35 with commensurate institutional support for these efforts. In 2021, the Alliance for Academic Internal Medicine (AAIM) published evidence-based recommendations for reducing the effects of structural and individual bias in the internal medicine (IM) clerkship grading process.…”

Section: Discussionmentioning

confidence: 99%

“…In 2021, the Alliance for Academic Internal Medicine (AAIM) published evidence-based recommendations for reducing the effects of structural and individual bias in the internal medicine (IM) clerkship grading process. 29 These recommendations include strategies for faculty development on mitigation of bias in narrative assessments of students, modifications of how grades are determined (e.g., weighted standardized examinations, direct observations, criterion-referenced assessments) and by whom (e.g., grading committees), and adoption of quality improvement processes using a proequity lens. 29 IM clerkship directors (CDs) hold important leadership roles in undergraduate medical education and are well positioned to promote equity in the learning environment.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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PurposeEquity in assessment and grading has become imperative across medical education. Although strategies to promote equity exist, there may be variable penetrance across institutions. The objectives of this study were to identify strategies internal medicine (IM) clerkship directors (CDs) use to reduce inequities in assessment and grading and explore IM CDs' perceptions of factors that impede or facilitate the implementation of these strategies. MethodFrom October to December 2021, the Clerkship Directors in Internal Medicine of the Alliance for Academic Internal Medicine conducted its annual survey of IM core CDs at 137 U.S. and U.S. territory-based medical schools. This study is based on 23 questions from the survey about equity in IM clerkship assessment and grading.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…This assessment is a means of quantifying the subjective evaluation of students from faculty and residents across all clerkships. On the CSC, we saw variation in the number of EE achieved across Academic Years, especially a large change from a median of 8 [IQR: [3][4][5][6][7][8][9][10][11][12] in 2017 to 13 [IQR: 7-17] in 2018, with leveling off to 11-11.5 in 2019-2020. This could reflect the growing pains and faculty adjusting to the grading system, but this would need validation over additional years.…”

Section: Subjective Assessment: Clinical Performance Assessmentmentioning

confidence: 99%

“…This is especially true within the core surgical clerkship (CSC), with its perceptions of increased clinical time demands [1], call requirements [2][3][4][5], variations in teaching modalities [2,6] and differing experiences among surgical subspecialties [7]. The equity lens is a very compelling challenge to the status quo, with growing evidence that under-represented in medicine groups experience inequity at multiple levels including Data from this manuscript were presented at the Association for Surgical Education 2022 Annual Meeting on May 3, 2022. clerkship grading, resulting in significant barriers to successfully matching into competitive residencies [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Measuring what matters: identifying assessments that reflect learning on the core surgical clerkship

et al. 2022

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Purpose There are various assessments used during the core surgical clerkship (CSC), each of which may be influenced by factors external to the CSC or have inherent biases from an equity lens. In particular, the National Board of Medical Examiners’ Clinical Subject Exams (“Shelf”) is used heavily and may not reflect clerkship curriculum or clinical learning. Methods This is a retrospective review of medical student characteristics and assessments during the CSC from July 2017-June 2021. Assessment methods included: subjective Clinical Performance Assessments (CPA), Shelf, Objective Structured Clinical Examinations, and a short-answer in-house examination (IHE) culminating in a Final Grade (FG) of Honors/Pass/Fail. A Shelf score threshold for Honors was added in academic years 2020–2021. Descriptive, univariate, and multivariable logistic and linear regression statistics were utilized. Results We reviewed records of 192 students. Of these, 107 (55.7%) were female, median age was 24 [IQR: 23–26] years, and most were White/Caucasian ( N = 106, 55.2%). Univariate analysis showed the number of Exceeds Expectations obtained on CPA to be influenced by surgical subspecialty taken ( p = 0.013) and academic year ( p < 0.001). Shelf was influenced by students’ race ( p = 0.009), timing of CSC before or after Internal Medicine (67.9 ± 7.3 vs 72.9 ± 7.1, p < 0.001), and Term taken (increasing from 66.0 ± 8.7 to 73.4 ± 7.5, p < 0.001). IHE scores did not have any external associations. After adjustment with multivariable logistic and linear regressions, CPA and IHE did not have external associations, but higher scores were obtained on Shelf exam in Terms 3, 5, and 6 (by 4.62 [95% CI 0.86–8.37], 4.92 [95% CI 0.53–9.31], and 7.56 [95% CI 2.81–12.31] points, respectively. Odds of FG honors were lower when Shelf threshold was implemented (OR 0.17 [95% CI 0.06–0.50]), and increased as students got older (OR 1.14 [95% CI 1.01–1.30]) or on specific subspecialties, such as vascular surgery (OR 7.06 [95% CI 1.21–41.26]). Conclusions The Shelf is substantially influenced by temporal associations across Terms and timing in relation to other clerkships, such as Internal Medicine. An IHE reflective of a clerkship’s specified curriculum may be a more equitable summative assessment of the learning that occurs from the CSC curriculum, with fewer biases or influences external to the CSC. Supplementary Information The online version contains supplementary material available at 10.1007/s44186-022-00047-8.

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Innovations report: A grading committee for a required fourth‐year emergency medicine clerkship

Thompson,

Rivera,

Katz

et al. 2024

AEM Education and Training

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BackgroundAssessment of medical students in the clinical learning environment is fraught with challenges. Seemingly small variations in clinical clerkship evaluation can significantly impact a student's future. As such, the integrity of the grade selection process must be heavily scrutinized. Group decision making in the form of a clerkship grading committee may be part of a solution to address this complex problem.MethodsWe conducted a retrospective observational study to describe grading committee decisions for a required fourth‐year EM clerkship from August 2021 to April 2022. Literature on best practices for group decision making and assessment were reviewed. This informed the development and implementation of the committee process. Each committee meeting was video recorded and coded for discussion time per student, times the committee grade differed from historical‐grade cutoffs with reasoning, and the frequency a committee member voiced a first‐hand account of student performance.ResultsData from nine meetings was reviewed (86 students). The mean discussion time per student was 2 min 13 s (range 11 s to 9 min 22 s). The final committee decision differed from historical‐grade cutoffs for nine students (10%), six were adjusted above and three below. In 64% (55/86) of student reviews a committee member voiced a first‐hand experience of working with the student. Positive grade adjustments were made due to outlier evaluations and negative adjustments were made for professionalism concerns.ConclusionsGrading committees are a means to conduct a comprehensive review of student performance and offer shared ownership of the grade decision among committee members. More study is needed to directly determine their potential benefit and role in clerkship grading.

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Aiming for Equity in Clerkship Grading: Recommendations for Reducing the Effects of Structural and Individual Bias

Cited by 14 publications

References 52 publications

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

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

Measuring what matters: identifying assessments that reflect learning on the core surgical clerkship

Innovations report: A grading committee for a required fourth‐year emergency medicine clerkship

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