The Discouraging Inadequacy of Clerkship Grades to Evaluate Medical Students-Are We Ready for Solutions?

Race and Gender Bias in Clerkship Grading

Phenomenon: Existing literature, as well as anecdotal evidence, suggests that tiered clinical grading systems may display systematic demographic biases. This study aimed to investigate these potential inequities in-depth. Specifically, this study attempted to address the following gaps in the literature: (1) studying grades actually assigned to students (as opposed to self-reported ones), (2) using longitudinal data over an 8-year period, providing stability of data, (3) analyzing three important, potentially confounding covariates, (4) using a comprehensive multivariate statistical design, and (5) investigating not just the main effects of gender and race, but also their potential interaction. Approach: Participants included 1,905 graduates (985 women, 51.7%) who received the Doctor of Medicine degree between 2014 and 2021. Most of the participants were white (n = 1,310, 68.8%) and about one-fifth were nonwhite (n = 397, 20.8%). There were no reported race data for 10.4% (n = 198). To explore potential differential grading, a two-way multivariate analysis of covariance was employed to examine the impact of race and gender on grades in eight required clerkships, adjusting for prior academic performance. Findings: There were two significant main effects, race and gender, but no interaction effect between gender and race. Women received higher grades on average on all eight clerkships, and white students received higher grades on average on four of the eight clerkships (Medicine, Pediatrics, Surgery, Obstetrics/Gynecology). These relationships held even when accounting for prior performance covariates. Insights: These findings provide additional evidence that tiered grading systems may be subject to systematic demographic biases. It is difficult to tease apart the contributions of various factors to the observed differences in gender and race on clerkship grades, and the interactions that produce these biases may be quite complex. The simplest solution to cut through the tangled web of grading biases may be to move away from a tiered grading system altogether.

Predictors of Success in an Orthopaedic Residency

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Orthopaedic surgery is one of the most competitive residencies to match into. Meanwhile, the average applicant's United States Medical Licensing Examination (USMLE) test scores, research involvement, and number of clinical honors increase every year.

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Measures such as USMLE scores, productivity in research, Alpha Omega Alpha (AΩA) honor society status, number of clinical honors, and performance on away rotations have all been cited as factors contributing to program directors choosing applicants for interviews and ranking them for their program. However, questions remain as to whether these measures translate to success on board examinations, high faculty evaluations, and designation as chief resident during orthopaedic residency.

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USMLE scores have been shown to correlate with Orthopaedic In-Training Examination (OITE) and American Board of Orthopaedic Surgery (ABOS) scores, while clinical grades and AΩA status correlate with faculty evaluations. Participating in research as a medical student was predictive of research productivity in residency but did not correlate with standardized testing scores or faculty evaluations.

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The literature has suggested ways in which measures such as personality and grit may be used in the application process and how these factors may contribute to predictors of success. However, additional research is needed to measure and define personality and grit during the application evaluation process.