In Pursuit of Honors: A Multi-Institutional Study of Students' Perceptions of Clerkship Evaluation and Grading.

PURPOSE: To examine medical students' perceptions of the fairness and accuracy of core clerkship assessment, the clerkship learning environment, and contributors to students' achievement. METHOD: Fourth-year medical students at 6 institutions completed a survey in 2018 assessing perceptions of the fairness and accuracy of clerkship evaluation and grading, the learning environment including clerkship goal structures (mastery- or performance-oriented), racial/ethnic stereotype threat, and student performance (honors earned). Factor analysis of 5-point Likert items (1 = strongly disagree, 5 = strongly agree) provided scale scores of perceptions. Using multivariable regression, investigators examined predictors of honors earned. Qualitative content analysis of responses to an open-ended question yielded students' recommendations to improve clerkship grading. RESULTS: Overall response rate was 71.1% (666/937). Students believed that being liked and particular supervisors most influenced final grades. Only 44.4% agreed that grading was fair. Students felt the clerkship learning environment promoted both mastery and performance avoidance behaviors (88.0% and 85.6%, respectively). Students from backgrounds underrepresented in medicine were more likely to experience stereotype threat vulnerability (55.7% vs 10.9%, P < .0005). Honors earned was positively associated with perceived accuracy of grading and interest in competitive specialties while negatively associated with stereotype threat. Students recommended strategies to improve clerkship grading: eliminating honors, training evaluators, and rewarding improvement on clerkships. CONCLUSIONS: Participants had concerns around the fairness and accuracy of clerkship evaluation and grading and potential bias. Students expressed a need to redefine the culture of assessment on core clerkships to create more favorable learning environments for all students.

The association between intolerance of ambiguity and decline in medical students' attitudes toward the underserved.

PURPOSE: Little published research details the risk factors for the decline in students' attitudes toward underserved populations during medical school. The authors assessed the association between this attitude change and intolerance of ambiguity (the tendency to perceive novel or complex situations as sources of threat), since treating underserved populations often involves a high level of complexity. METHOD: The University of New Mexico School of Medicine administered a survey assessing attitudes toward underserved populations at matriculation and at graduation to seven consecutive medical school classes (matriculation years 1999 to 2005). The university also administered a survey measuring tolerance of ambiguity at matriculation. Five hundred twenty-nine students were eligible to complete both surveys between 1999 and 2009. RESULTS: Three hundred thirteen (59%) students completed the attitude survey at matriculation and graduation. Attitude scores for a majority of students (69%) decreased from matriculation to graduation. Changes in scores ranged from +25 to -35; the average change was -4.5. Linear regression analysis showed that those who were tolerant of ambiguity (top 20% of tolerance of ambiguity scores) were significantly less likely to have declines in attitudes toward the underserved; the coefficient was 3.69 (P = .003). Other factors independently associated with maintaining high attitude scores were being female and starting medical school at age 24 or younger. CONCLUSIONS: Attention to, and practice with, ambiguous situations may help moderate decreases in attitudes toward underserved populations. Medical education should address the fact that physicians face much ambiguity and should offer students tools to help them respond to ambiguous clinical situations.