Clinical Rotations

Find better ways to do medical student clerkship grading

Brendan Murphy , Senior News Writer

The subjective nature of grading medical students on performance during clinical rotations has come under scrutiny for its unreliability. Research indicates that despite the weighting of clinical clerkship grades in residency applicant selection, these grades are currently inconsistent and biased, according to an AMA Council on Medical Education presented at the 2023 AMA Annual Meeting.

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Clerkship grades are often subjective and medical schools need to improve the consistency and fairness of their grading systems. This includes teaching faculty to be more aware of structural inequities and implicit biases that may influence their assessment of students.

“Inequity in clinical clerkship assessment may be one symptom of the wider culture of systemic bias as well as a reflection of the current learning environment of competition within medical education,” says the council’s report.

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“Without a greater shift within medical education’s values, or without tending to the entire landscape of medical education, modifying one component piece may send varying intended and unintended ripple effects outwards to the other components of learner assessment—potentially shifting pressure and bias from one area to another, and having unknown and heterogeneous effects on a variety of learners. It is difficult to assess only one piece of the overall system to reflect an understanding of overall equity in assessment, and even more challenging to correct only one piece of a much wider puzzle.”

To address these concerns, the House of Delegates directed the AMA to “continue to encourage work in support of the Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee “Recommendations for Comprehensive Improvement of the UME-GME Transition.”

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Delegates also adopted new policy to encourage and support:

  • UME institutions’ investment in developing more valid, reliable and unbiased summative assessments for clinical clerkships, including development of assessors’ awareness regarding structural inequities in education and wider society.
  • Providing standardized and meaningful competency data to program directors.

In addition, delegates adopted policy to encourage:

  • Institutions to publish information related to clinical clerkship grading systems and residency match rates, with subset data for learners from varied groups, including those that have been historically underrepresented in medicine or may be affected by bias.
  • UME institutions to include grading system methodology with grades shared with residency programs.