Grade Inflation in Internal Medicine Clerkships: Results of a National Survey

Speer, Alice J.; Solomon, David; Fincher, R M

doi:10.1207/s15328015tlm1203_1

Cited by 49 publications

(27 citation statements)

References 3 publications

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“…Several factors may contribute to poor performance, such as study skills and/ or personal problems (Tooth et al 1989;Cleland et al 2005). The complex patterns of assessment in medicine mean that struggling students may continue with little guidance or support (Sayer et al 2002) and supervising clinicians are often reluctant to fail under-performance (Speer et al 2000;Dudek et al 2005;Cleland et al 2008b). Thus, students' learning problems remain unaddressed, leading to repeated failure and under-performance (Tooth et al 1989;Cleland et al 2005).…”

Section: Introductionmentioning

confidence: 99%

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

et al. 2010

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Background: Intervention may help weaker medical students improve their performance. However, the effectiveness of remedial intervention is inconclusive due to small sample sizes in previous studies. We asked: is remedial intervention linked to a formative assessment effective in terms of improving student performance in subsequent degree examinations? Methods: This was a retrospective, observational study of anonymous databases of student assessment outcomes. Data were analysed for students due to graduate in the years 2005-2009 (n ¼ 909). Exam performance was compared for students who received remediation versus those who did not. The main outcome measure was summative degree examination marks. Results: After adjusting for cohort, gender, overseas versus home funding, previous degree and previous performance in the corresponding baseline third year summative exam, students receiving a remedial intervention (after poor performance on a formative objective structured clinical examination and written exams mid-fourth year) were significantly more likely to obtain an improved mark on end-of-fourth year summative written ( p ¼ 0.005) and OSCE ( p ¼ 0.001) exams compared to those students who did not receive remediation. Conclusion: A remedial intervention linked to poor assessment performance predicted improved performance in later examination. There is a need for prospective studies in order to identify the effective components of remedial interventions.

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Section: Introductionmentioning

confidence: 99%

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

et al. 2010

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“…The leniency observed in this evaluation is perceived as a pervasive problem in all forms of higher education, including postgraduate medical education (Speer et al 2000;Thompson et al 1990;Kreiter and Ferguson 2002;Dudek et al 2005). The scores for trainee assessment show that the majority or a large minority of trainees perform better than expected in every competence construct, suggesting an elite group of trainees with a ceiling effect, supervisors with low expectations, or other issues of leniency bias (Murphy and Balzer 1989).…”

Section: Variance Component Analysismentioning

confidence: 74%

Supervisor assessment of clinical and professional competence of medical trainees: a reliability study using workplace data and a focused analytical literature review

McGill

Vleuten

Clarke

2011

Adv in Health Sci Educ

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Even though rater-based judgements of clinical competence are widely used, they are context sensitive and vary between individuals and institutions. To deal adequately with rater-judgement unreliability, evaluating the reliability of workplace rater-based assessments in the local context is essential. Using such an approach, the primary intention of this study was to identify the trainee score variation around supervisor ratings, identify sampling number needs of workplace assessments for certification of competence and position the findings within the known literature. This reliability study of workplace-based supervisors' assessments of trainees has a rater-nested-within-trainee design. Score variation attributable to the trainee for each competency item assessed (variance component) were estimated by the minimum-norm quadratic unbiased estimator. Score variance was used to estimate the number needed for a reliability value of 0.80. The trainee score variance for each of 14 competency items varied between 2.3% for emergency skills to 35.6% for communication skills, with an average for all competency items of 20.3%; the "Overall rating" competency item trainee variance was 28.8%. These variance components translated into 169, 7, 17 and 28 assessments needed for a reliability of 0.80, respectively. Most variation in assessment scores was due to measurement error, ranging from 97.7% for emergency skills to 63.4% for communication skills. Similar results have been demonstrated in previously published studies. In summary, overall supervisors' workplace based assessments have poor reliability and are not suitable for use in certification processes in their current form. The marked variation in the supervisors' reliability in assessing different competencies indicates that supervisors may be able to assess some with acceptable reproducibility; in this case communication and possibly overall competence. However, any continued use of this format for assessment of trainee competencies necessitates the identification of what supervisors in different institutions can reliably assess rather than continuing to impose false expectations from unreliable assessments.

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“…First, with the introduction of the block/modular curriculum, students may have been able to better focus on the courses, especially those that were considered "smaller" or "minor" and often neglected in the longitudinal curriculum, where major courses such as Anatomy, Physiology, and Pathology were students' priority throughout the study year. Second, there is a general trend of upward shift in medical students' grade-point average (23,24). The third explanation is based on the finding of our qualitative inquiry that the introduction of the block/modular curriculum may have forced teachers to lower or adjust their grading criteria to accommodate for the fact that students' knowledge was less than satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Transition from Longitudinal to Block Structure of Preclinical Courses: Outcomes and Experiences

et al. 2009

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Aim To evaluate the transition from a longitudinal to block/modular structure of preclinical courses in a medical school adapting to the process of higher education harmonization in Europe.Methods Average grades and the exam pass rates were compared for 11 preclinical courses before and after the transition from the longitudinal (academic years 1999/2000 to 2001/2002) to block/modular curriculum (academic years 2002/2003 to 2004/2005) at Zagreb University School of Medicine, Croatia. Attitudes of teachers toward the 2 curriculum structures were assessed by a semantic differential scale, and the experiences during the transition were explored in focus groups of students and teachers.Results With the introduction of the block/modular curriculum, average grades mostly increased, except in 3 major courses: Anatomy, Physiology, and Pathology. The proportion of students who passed the exams at first attempt decreased in most courses, but the proportion of students who successfully passed the exam by the end of the summer exam period increased. Teachers generally had more positive attitudes toward the longitudinal (median [C]±intequartile range [Q], 24 ± 16) than block/modular curriculum (C±Q, 38 ± 26) (P = 0.001, Wilcoxon signed rank test). The qualitative inquiry indicated that the dissatisfaction of students and teachers with the block/modular preclinical curriculum was caused by perceived hasty introduction of the reform under pressure and without much adaptation of the teaching program and materials, which reflected negatively on the learning processes and outcomes.Conclusion Any significant alteration in the temporal structure of preclinical courses should be paralleled by a change in the content and teaching methodology, and carefully planned and executed in order to achieve better academic outcomes.

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Grade Inflation in Internal Medicine Clerkships: Results of a National Survey

Abstract: Statistically significant grade inflation exists in Internal Medicine clerkships. Most disturbingly, 43% feel we are unable appropriately to identify incompetent students.

Cited by 49 publications

References 3 publications

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

A remedial intervention linked to a formative assessment is effective in terms of improving student performance in subsequent degree examinations

Supervisor assessment of clinical and professional competence of medical trainees: a reliability study using workplace data and a focused analytical literature review

Transition from Longitudinal to Block Structure of Preclinical Courses: Outcomes and Experiences

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