Grading Overview: Third-Year Clerkships

During Foundations 2, students are evaluated largely based on their contributions in the workplace. Thus, evaluation occurs somewhat differently than in the previous years of largely classroom-based and CMC training. Clerkships are workplace settings, not classroom settings, and in these environments several factors are much more important than they were previously:

1. Students are evaluated from day one by a number of different supervisors, each of whom has a unique role on the service and a unique set of skills and goals.

a. In team-based environments, students are evaluated through the particular “expectation lens” of each of their supervisors.

b. A student’s evaluation will represent an integrated assessment of all team members’ opinions. There is not a single definition of ‘outstanding’ or ‘poor’ performance.

c. It is helpful to keep in mind that there is no way to ensure total consistency in each individual supervisor’s approach to completing evaluations.

d. Each clerkship director working with a grading committee, however, maintains a consistent approach to integrating all supervisor feedback.

2. Students are evaluated for their ability to communicate knowledge as much as their ability to acquire or retain it, as well as their ability to demonstrate synthesis of different sources of knowledge (patients, supervisors, textbooks, journal articles, lab tests, interview, and exam findings).

3. Students are expected to achieve proficiency in each of the competencies listed on the evaluation form. This is the basis for a grade of “Pass.” If a student does not pass, it will be because this student did not achieve proficiency in at least one of the competencies.

Here is a comparison of the grading across core clerkships:

Clerkship	Grading process	Components used for grade	Exam
Anesthesia 110	Grading committee assigns grades. The site director completes the summary evaluation and then the clerkship director completes the final course summary evaluation. The grade is based on both evaluation scores and educator comments.	Overall grade based on achieving expectations for clinical performance. Grading is pass/fail only.	No exam
Family & Community Medicine 110	Grading committee assigns grades and writes summaries in a collaborative manner. The grade is based on evaluation scores, educators’ comments, passing the final exam, and participation in FCM seminars.	Overall grade based on achieving expectations for clinical performance, clerkship exam, and completion of online cases. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Medicine 110	Grading committee assigns grades, site directors write summaries, and clerkship director approves grades.	Overall grade based on achieving expectations for clinical performance and clerkship exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Neurology 110	Grading committee assigns grades. The clerkship director writes the summary evaluation using language drawn from evaluator comments. Grades are based upon evaluation scores and exam scores, which are weighted proportionally then added together to yield a total clerkship score.	Overall grade based on achieving expectations for clinical performance and clerkship exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Obstetrics & Gynecology 110	Grading committee assigns grades and writes summary evaluations. The grade is based on evaluation scores and educator comments, and the exam score.	Overall grade based on achieving expectations for clinical performance and clerkship exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Pediatrics 110	Grading committee assigns grade. The site director writes the summary evaluation which is approved by the clerkship director. The grade is based on evaluation scores and educator comments, and the exam score.	Overall grade based on achieving expectations for clinical performance and clerkship exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Psychiatry 110	Grading committee makes recommendations to the clerkship director. The clerkship director assigns grades and writes summaries. The grade is based on evaluation scores and educator comments, and the exam score. For longitudinal clerkships, final RIME weighs more.	Overall grade based on achieving expectations for clinical performance and clerkship exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.
Surgery 110	Grading committee assigns grade. The clerkship director writes summaries. The grade is based on evaluation scores and educator comments, and the exam score.	Overall grade based on achieving expectations for clinical performance, clerkship exam, and observed physical exam. Grading is pass/fail only.	Must score at or above the 3rd percentile of the NBME national average to pass exam. Must pass the exam to pass the clerkship.