Who Should Get Honors?

Evaluation: This large survey study of medicine and pediatric inpatient clerkship faculty had a respectable 62% response rate.  Attendings were asked to describe their impressions of the evaluation/honors system and rank a total of 24 student characteristics in terms of their importance to giving an honors grade.  Even though 81% reported receiving no training on which students should receive honors, 86% felt that they could readily identify the high-performing student.  Eighty-three percent thought that fewer than 25% of their students should receive an honors designation.  Of the 24 student characteristics, 21 fell into three domains: professional behaviors (Factor 1), teamwork and communication skills (Factor 2), and systems-based behaviors such as evidence-based medicine practice and patient safety skills (Factor 3).  The five top-rated student characteristics were taking ownership of patients, clinical reasoning, curiosity, dependability, and high ethical standards.  All of these except clinical reasoning fell into Factor 1, the professional behavior domain.    Students who want honors, be aware that these are the characteristics your attendings are looking for! — Laura Willett, MD

Student Perspective: Clerkship grading and evaluations are a major source of stress for medical students. Students are acutely aware of the impact clinical grades have on their MSPE and their overall residency application.  There is sometimes significant variability between clinical sites and evaluator grading even within clerkships, which can add to students’ stress.  A single evaluator with a poor understanding of the rubric can sometimes be the difference between grade levels.  I think most students would be disheartened to read about the degree of variability not only of grading systems, but also of MSPE summative performance evaluations across medical schools.  You can see why residency programs place so much emphasis on an objective measurement like USMLE Step 1 score.  It is unrealistic for medical schools to have the same clerkship grading system.  However, there should be a requirement that schools disclose the percentages of students receiving each grade per clerkship to increase transparency.  Perhaps there should also be some standardization for the summative evaluation including a standard group of adjectives and/or reporting the student’s rank in terms of quartile.  These are important discussions to have, especially as the role of Step 1 is being reconsidered. — Rebecca Krakora (4th Year Medical Student)

Herrera LN, Khodadadi R, Schmit E, Willig J, Hoellein A, Knudson C, Law K, Mingioni N, Walsh K, Estrada C, Williams W. Which Student Characteristics Are Most Important in Determining Clinical Honors in Clerkships? A Teaching Ward Attending Perspective. Acad Med. 2019

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