Medicine Clerkship Grading and Evaluation

General Information

Each clerkship site is committed to providing as much feedback as possible.  You will receive feedback about your performance in an ongoing way during the clerkship from your interns, residents and teaching attendings. Each time you are corrected in any way, feedback has occurred.  The more you solicit feedback and the more open you are to correction, the more feedback you will receive.  The most important thing you can do is be specific in your requests. The more global the request, the more global the response. Asking “How’m I doing?” after two weeks will often produce a response such as “You have a great attitude. Your knowledge is good. Try to read more.” Asking “How can I be more involved in morning rounds?” or “How can I make my presentations more concise?” will more likely provide you more specific and helpful feedback. Immediate feedback is usually more specific and more likely to effect change.

You are being evaluated in an ongoing way by your interns, resident, attendings, tutors and site directors. These evaluations will be summarized by your site director at the end of each 4 week period. At the end of each inpatient block, you will meet with your site director and receive a written evaluation of you clinical performance. Click here to see the evaluation form. This is a summary of the overall assessment of your performance, relative to the goals that have been set out for you. The site director will give you some advice on how to improve your performance. Often the written evaluation will list “areas of improvement”. However, remember, this 4 week evaluation is primarily a summary or description of your clinical performance. It is used to calculate your grade (as described below). Feedback mostly comes directly from the doctors with whom you care for patients. 

Department of Medicine Grading Policy for the Junior Clerkships

A. The student’s clinical performance is the major determinant of the grade. It is possible that all students could perform clinically at an Honors level or no students could perform at an Honors level. In the past, a student has failed the clerkship every other year and 1-3 students have passed with remediation. 

B. Your grade is primarily determined by your clinical evaluation as one can see from our grading formula:

       Final grade =

       30% Hospital site I clinical evaluation +

       30% Hospital site II clinical evaluation +

       10% Specialty month clinical evaluation +

       20% NBME +

       10% OSCE

       Max score = 100, typical range 70-90

       Honors cut-off >86

       High Pass cut-off>81

C. Your clinical evaluation at each hospital site will be reflected in the Site Evaluation form. The sum of the scores from each of these 8 categories is used to determine your final grade. The scores in the categories of oral presentation skills, professionalism, patient/team relationships, and initiative are calculated almost entirely from your ward teams (interns, residents, and attendings), who are in the best position to evaluate these items. In four other areas (fund of knowledge, problem solving skills, physical exam skills, and record keeping) the evaluation from your site director (and tutor at Evanston) will be added to the evaluation from your ward teams.  The most important comments from the intern, resident and faculty evaluations are communicated either verbally at the site director meeting or written in the 4–week evaluation, but occasionally a student wishes to read the original evaluations. After the 4 weeks is completed the student may contact the site administrator and view their original evaluations. 

D. The final examination focuses upon assessment of knowledge base, test interpretation, and clinical diagnostic reasoning abilities.  The internal medicine subject examination of the National Board of Medical Examiners is given in a 2 hour and 10 minute session on the last day of the clerkship.  A failing score for clerkship purposes is a subject test score that is less than 10% of the national reference group. A repeat examination will be taken within 3 months after the end of the quarter. Ninety percent of NUMS students who retake the test, pass it. A second failure on the examination will result in a grade of fail and necessitate a repeat of the clerkship.

E. Any student performing in marginal fashion at one of the 4-week sites will be formally notified by the site director. Often, the site director will notify the student before the end of the 4 week block. It would be rare for a student to hear of a failing performance only at the end of the rotation, but occasionally if the student’s performance deteriorates late in the rotation, the student could fail the rotation without early notification

F. The final decision about grading, failure and remediation will be made at the quarterly site directors’ meeting that occurs soon after each rotation is completed. A student’s final grade will only be lowered at this meeting if a student has received a marginal form, a professionalism form or received a clinical performance score below expectations (<4) in any category from any site. (In other words, there will be no surprises.)      

1) The only way a student can fail the clerkship clinically is if a student receives a clinical performance score below expectations (<4) in any category from either site. Remediation is rarely required for one low score (eg. the majority of students who receive a score <4 do not fail or require remediation.) 

2) A student may receive a pass with remediation if the student’s total score is <72 and the site directors believe that extra clerkship time will improve the student’s clinical performance.

G. It takes two-three weeks to receive the results from the NBME. We usually have our site director meeting three weeks after the end of your clerkship. If you complete the course evaluation, your final grade and evaluation will be available within a month of the end of the clerkship.