Gregory J. Magarian

A National Survey of Grading Systems Used in Medicine Clerkships.

To better understand the variety in U.S. medicine clerkship grading terminology, the number of grading levels, and the distribution of grades within each level, the authors surveyed medicine clerkship directors in the United States and Puerto Rico in 1986 and 1987. Completed questionnaires were returned from 101 of the 124 medical schools (81%). Descriptor grades were the most commonly used form of grading of medicine clerks, used in 68 of the 101 responding schools; letter grades were used by another 28 of the schools; and four schools used a numerical grading system. Although descriptor grades were most commonly used for grading medicine clerks, there was lack of consistency in their use between schools. The authors discuss the data related to letter grades and descriptor grades across this representative sample of U.S. medical schools.

A tutorial for students demonstrating adequate skills but inadequate knowledge after completing a medicine clerkship at the Oregon Health Sciences University.

Upon completing a clinical clerkship, some students demonstrate adequate clinical skills appropriate for that clerkship but do not demonstrate an adequate fund of knowledge or ability to apply their knowledge clinically. For such students, repeating all or a portion of the clerkship may not be appropriate. This study describes a tutorial provided such students after they had completed the medicine clerkship at the Oregon Health Sciences University. During a two-year period (academic years 1988–89 and 1989–90), six students were identified as needing remediation, and were enrolled in a tutorial coordinated by one faculty member with support from others. The experience was highly successful for all but one student, and the tutorial was uniformly viewed by the students who took it as one of their best experiences in medical school.

The procedural and interpretive skills that third-year medicine clerks should master: views of medicine clerkship directors.

The authors surveyed medicine clerkship directors to determine which procedural and interpretive skills they felt third-year medical students should acquire. Of the 101 (81%) who responded, 91 felt that specific procedural and interpretive skills should be achieved by the end of the third-year medicine clerkship. Twenty-seven percent of these 91 reported having students keep a record of their activities; 35% reported testing students in the interpretation of various tests used in the evaluation of hospitalized patients on medicine services; and one clerkship director reported that his students were tested in their abilities to perform procedures. There was substantial disagreement by medicine clerkship directors over the procedural and test/study-interpretation skills in which medicine clerks should become proficient during the third-year medicine clerkship.

Does performance on the NBME part II medicine examination when used as a clerkship examination reflect knowledge acquired during the medicine clerkship

Objective:The purpose of this study was to examine whether the National Board of Medical Examiners (NBME) Medicine Examination provides a reasonable assessment tool for testing students’ knowledge acquired during a medicine clerkship.Design:Comparison of the performances of two classes of medical students on the NBME Part II Medicine Examination on the first and last days of 12-week medicine clerkships in a two-year period (1985–87).Participants:176 medical students in two consecutive classes at the Oregon Health Sciences University.Measurements and results:There was no significant difference in students’ performances on the NBME Part II Medicine Examination on the first day of the medicine clerkship, regardless of the quarter in which they took the clerkship. Prior clerkship experiences did not appear to influence the baseline pre-clerkship internal medicine knowledge base as defined by NBME Part II Medicine Examination performances. Students in the second half of the year, however, demonstrated greater gains in post-clerkship NBME Part II Medicine Examination performances than did their counterparts from the first half of the year, despite similar pre-clerkship testing performances.