Factors Associated with Grade Appeals: A Survey of Psychiatry Clerkship Directors

Abstract

A grade appeal is often the final step in the grading process for medical students. By identifying factors that contribute to grade appeals, areas for targeted interventions in the evaluation process are potentially identified. Future study of grade appeals, including from the medical students' perspective, is warranted.

Grade Appeals in the Internal Medicine Clerkship: A National Survey and Recommendations for Improvement

“…Our findings add to the only other published study of clerkship grade appeals, which analyzed North American psychiatry clerkships. 8 The majority (92%) of internal medicine clerkships had a defined process for conducting a formal grade appeal, and in most cases this review was led by the clerkship director. Nearly two-thirds of clerkships reported a process for a second appeal, and one-third allowed for a third appeal.…”

“…These factors may include grade inflation, 3,4 variation and imprecision of clerkship grading, 5,6 inadequate feedback in the clinical workplace, 7 and the perceived need for clerkship honors to attain residency goals. 8 A formal grade appeal allows students the opportunity to voice concerns if they feel that their grade does not accurately reflect their performance due to an error, discrimination, or bias. Liaison Committee on Medical Education Standard 9.9 requires that medical schools have procedures that "permit a medical student to review and to challenge the student's educational records .…”

“…9 Despite accreditation requirements for having a procedure to challenge grades, little is known about the prevalence of grade appeals, how schools handle the appeals process, and what specific factors may be driving appeals. Thomas et al 8 surveyed North American psychiatry clerkship directors and found an average grade challenge rate of 4.5% (range 0-17%). Clerkships with an honors/pass/fail grading system had a significantly higher challenge rate than clerkships with other schemas, and clerkships where a grade appeal could result in a lower grade had significantly lower challenge rates.…”

Imprecise Clinical Assessments and Inaccurate Grades: Family Medicine Clerkship Director Perspectives

“…10 One measure of student concern, the grade challenge rate, has been described in other clerkships as ranging from 4.5% to 8.0% of students in a given year. 11,12 Family medicine clerkships may be especially subject to student concerns about fairness, given the diversity of academic, community, and volunteer faculty who perform clinical assessments. Grade inflation has been identified as a particular challenge for family medicine clerkship directors (FMCDs).…”

Why Are Students Appealing Clerkship Grades? A Multischool Root Cause Analysis

“…2 Contemporaneously, clerkship grade appeals were becoming noticeable enough to clerkship directors in medicine (CDIM) and psychiatry that national surveys were conducted to begin to quantify the prevalence of these appeals and try to understand reasons for them. 3,4 In noting that significant institutional resources were being expended in addressing the present levels of student grade appeals, our group sought to extend the literature by engaging in a systematic analysis of grade appeals across 6 medical schools.…”