Alice J. Speer

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

Background: There has been a discussion among medical educators concerning grade inflation; however, little has been written about it in the medical education literature. Purpose: A survey was developed to determine if grade inflation exists by gathering data about grading practices and by gathering the opinions of course directors from Internal Medicine clerkships. Methods: The survey was administered during the 1996-1997 academic year to all 125 LCME accredited medical school Internal Medicine Clerkship Directors. Grading practices for 3 separate academic years were obtained plus responses to questions about causes of and solutions for grade inflation. Results: Eighty-three surveys were returned for a 66% response rate. There was a trend towards higher grades across the 3 study years, with the 1995-1996 year being statistically significant. Forty-eight percent of the clerkship directors felt that grade inflation existed in their courses, and 43% felt that some students passed who should have failed. Conclusion: Statistically significant grade inflation exists in Internal Medicine clerkships. Most disturbingly, 43% feel we are unable appropriately to identify incompetent students.

An innovative evaluation method in an internal medicine clerkship

No abstract available.

Grade Inflation and the Internal Medicine Subinternship: A National Survey of Clerkship Directors

Background: Grade inflation has been demonstrated in certain medical school clerkships but never studied in the internal medicine subinternship. Purposes: The purpose is to determine the existence, extent, and possible causes of subinternship grade inflation. Methods: We surveyed clerkship directors as part of the 2004 Clerkship Directors in Internal Medicine national member survey. Results: The majority of clerkship directors agree that subinternship grade inflation exists. Half of SI students receive Honors and one third receive High Pass. Eighteen percent admitted passing a student that they felt should have failed. Difficulty delivering negative feedback is the top explanation for grade inflation. Conclusion: Clerkship directors agree that grade inflation exists in the internal medicine subinternship. Faculty development and further analysis of our current subinternship evaluation and grading system may help to minimize this problem.

Evaluating problem solving based on the use of history findings in a standardized-Patient examination

PURPOSE. To evaluate a novel item format for assessing clinical problem solving in a standardized-patient examination (SPE). METHOD. In 1992–93 a key-findings item format was included in two versions of three stations in an SPE (given in the style of an objective structured clinical examination) that was taken by 198 third-year students at the end of their three-month internal medicine clerkship at the University of Texas Medical Branch at Galveston. Each of the stations involved an extended matching question that listed ten to 12 findings. The students were told to select as many or as few findings as they wished that were key in leading them to their diagnosis of the standardized patients (SPs) problem. The findings fell into three categories: (1) key to the diagnosis, (2) provided by the SP but not key to the diagnosis, and (3) not provided by the SP. RESULTS. A total of 169 students (85%) identified at least one of the findings determined to be key in each of the stations. Correctly identifying key findings was related to correctly diagnosing the SPs problem. A total of 145 students (73%) indicated at least one finding across the three cases as key to their diagnosis but not given by the SP. Selecting nonexistent findings as key to diagnosis was not found to be related to performance on the SPE. It was hypothesized that once a diagnosis was made, the students had difficulty differentiating key findings that had led them to the diagnosis from other key features of their cognitive model of illness. CONCLUSION. The students were generally able to obtain and recognize at least some of the key information they needed to formulate appropriate differential diagnoses, and the ability to identify key findings was shown to be related to identifying the most appropriate diagnosis. The key-findings item format has potential both in assessment and for gaining a better understanding of the clinical problem-solving process.

Investigating gender bias in preceptors' ratings of medical students

No abstract available.

The impact of the location and structure of an ambulatory rotation on cognitive knowledge and performance.

With the increasing shift to community-based ambulatory education, it is essential to gain a better understanding of the impact of these changes. To assess the impact of the location and structure of an ambulatory internal medicine clerkship rotation on cognitive knowledge and clinical performance, students were assigned to one of the following: (a) a multi-disciplinary ambulatory clerkship (MAC), (b) the office of a community-based general internist, or (c) a university-based internal medicine ambulatory clinic. The groups were compared on the internal medicine clerkship examination and preceptor ratings controlling for introduction to clinical medicine course performance via analysis of covariance. MAC students were rated lower than the other two groups by their preceptors. There were no other statistically significant differences. The structure and location of the rotation had little impact on cognitive knowledge. The impact of the structure of the rotation on clinical performance is less clear suggesting that further research is needed.

Developing a presentation and problem-solving station in a multistation standardized-patient examination.

No abstract available.

Dimensions of Clinical Competence as Conceptualized by Medical School Faculty

This study identified dimensions of clinical competence underlying faculty ratings of fourth-year student performance in a standardizedpatient examination and assessed the impact of these dimensions onfaculty pass/fail decisions. Content review coupled with exploratoryfactor analysis was used to group 17 of 25 specific behavioral rating categories intofourhomogeneous clusters. Confirmatory factor analysis refined the clusters into four unidimensional scales that included 14 of the original ratings. The dimensions reflected relating to the patient, problem-solving skills, medical history skills, and physical examination skills. The factor structure was crossvalidated in a separate data set. Logistic regression indicated problem solving was the only independent predictor of a student passing the exercise.

Assessing the invariance of a factor structure for a measure of clinical competence across examination formats

No abstract available.

A clinical evaluation form to improve faculty critique of students.

No abstract available.