Equity in Learning and Assessment in the Medical School Learning Environment

Purpose

To promote equity in the assessment of student performance and mitigate the risk of discriminatory and racialized assessment practices.

Overview

The UCSF School of Medicine is committed to equity in learning and assessment of student performance. Prior work by the School of Medicine identified population group differences in assessed performance of students in core clerkships and selection to the AOA honor medical society. These differences favored students from backgrounds not-under-represented in medicine. Similar findings arising at other medical schools reinforce the concern about structural factors creating inequity in learning and assessment. The School has since eliminated honors grades in core clerkships, suspended the AOA chapter at the institution, and embarked on Diversity, Equity and Inclusion champion training for faculty.  

In addition to existing structural factors that can create inequity, public events can occur that have the potential to disrupt learning for a large number of students and interfere with their ability to participate actively in the curriculum and assessments. These events may be traumatic for learners and often disproportionately affect some groups. These exigent circumstances require educational flexibility while still ensuring that learners satisfy course and clerkship requirements and achieve expected milestones for each curricular phase and for graduation in order to be prepared for physician practice.

Related LCME Standards

9.8 Fair and Timely Assessment

Principles

  • All students must achieve the MD competency milestones for each phase of the curriculum and for graduation. 
  • Medical education fosters learner wellbeing and professional identity formation in service to patients. 
  • Assessment of student performance must be free of harmful bias. 
  • The clinical learning environment must be diverse, equitable, and inclusive.  
  • The School should be alert to public events that interfere with students’ abilities to engage with the curriculum and should proactively identify ways for students to complete requirements, including examinations, on an alternate schedule.

Policy

  1. High-intensity teachers must complete training in diversity, equity, and inclusion. (see definition below) 
  2. Students who believe that the assessment of their performance was negatively affected by bias should report this to their program using one of the existing mechanisms for immediate action, including contacting a course or clerkship director, using the SAFE reporting system, or contacting the Associate Dean for Students.
  3. Assessment data review will occur regularly for the purpose of ensuring equity in assessment and identifying inequities that can then be addressed.
  4. In the context of exigent circumstances that create a disruption to learning for a large number of students, the School will implement the School of Medicine Protocol: Response to Racial and Other Social-Political Trauma.

Procedure

  1. Training: All undergraduate medical education high-intensity teachers (defined as those with ≥10% funded medical education roles), clerkship and site directors, other faculty with education leadership roles, and members of clerkship grading committees will complete Diversity, Equity, and Inclusion Champion training. All faculty also complete required campus-level Diversity, Equity, and Inclusion training. 
  2. Assessment of learner performance: Students who feel that assessment of their performance may have been negatively influenced by evaluator bias can report to their course/clerkship director, through the SAFE reporting system, or to the Associate Dean for Students. Reports are reviewed and discussed with the appropriate course/clerkship director. If the student self-identifies and requests follow up, the Associate Dean for Students will contact the student. When indicated, the appropriate campus office (Title IX, Title VII) is contacted. 
  3. Assessment data review:
    • To ensure fair, equitable assessment of student performance free of harmful bias, all clerkship directors and site directors will participate in Diversity, Equity, and Inclusion Training, as above.
    • The School conducts annual equity reports to identify any differences in student learning outcomes based on race/ethnicity. These data are reported to governance committees and corrective action is taken where needed. For the clinical portions of the curriculum, the metrics used include: 
      • Core clerkship numerical ratings
      • Clerkship exam scores, clerkship exam pass rate 
      • Medicine subinternship honors grades 
      • CPX performance 
      • Step 1 and Step 2 CK performance
    • Review of narrative comments describing students’ clerkship performance in evaluations occurs at multiple points for quality control, to allow for ensuring a lack of harmful bias in the summary evaluation for the MSPE and to allow for education for faculty evaluators where needed. This review occurs by clerkship and site directors, clerkship grading committees, and the MSPE team.
  4. Response to exigent circumstances. The School of Medicine Protocol: Response to Racial and Other Social-Political Trauma guides the implementation of communication from the course and clerkship leadership to individual teachers that the school has declared a situation to be a significant disruption to clinical learning.
    • Time away from the curriculum. In the event of a major event that disrupts students’ learning, the School will arrange for students to delay pre-clerkship or clerkship didactic learning sessions, assessment activities, and examinations, without penalty. This delay is activated through the School of Medicine Protocol: Response to Racial and Other Social-Political Trauma. Students must satisfy course and clerkship requirements at a later date to be determined by the student and course or clerkship director.
    • The student is not penalized for approved delayed deadlines or absences and these are not used to determine the course or clerkship grades or described in the summary evaluation content for the MSPE.
    • Clerkship students continue clinical activities in service to their patients unless otherwise arranged with the clerkship director.

Accountable Dean or Director: Associate Dean for Competency Assessment and Professional Standards  

Related Policies 

  1. Foundations 1 Policy on Attendance and Participation  
  2. Foundations 1 Grading and Assessment Policy
  3. Foundations 2 Attendance Policy 
  4. UCSF School of Medicine Foundations 2 Assessment and Grading Policy 
  5. Career Launch Attendance Policy

Approval Date and Governing Body: CCEP, October 06, 2020