Takayama Hiroo, Grinsell Rebecca, Brock Douglas, Foy Hugh, Pellegrini Carlos, Horvath Karen
Department of Surgery, University of Washington, Seattle, Washington 98195, USA.
Curr Surg. 2006 Nov-Dec;63(6):391-6. doi: 10.1016/j.cursur.2006.06.012.
This study challenges the appropriateness of using core clerkship grades for resident selection. The authors hypothesize that substantial variability occurred in the system of grading.
In this retrospective cross-sectional study, variability in the grading systems for third-year core clinical clerkships were examined. From the Medical Student Performance Evaluation of applicants from U.S. medical schools for residency training in the authors' department in 2004 and 2005, the authors gathered the following variables: medical school, third-year core clerkship grading systems, and percentage of students in each grade category. Descriptive analyses were conducted and within institution variability across clerkship scores was analyzed using repeated measure analysis of variance (ANOVA) and t-test.
University teaching hospital.
The survey covered 121 of 122 U.S. medical schools accredited by the AAMC/LCME.
Grading systems used included: variations of Honors/Pass/Fail (H,P,F) system in 76 schools, letter grade systems in 22 schools, and other variants (eg, Outstanding, Advanced, and Proficient in 6 schools and Pass/Fail in 4 schools). Thirteen schools (10%) provided either no grading system or no interpretable system. Grading systems included were further defined into 2 scores in 6 schools, 3 in 34 schools, 4 in 38 schools, 5 in 23 schools, and more than 6 in 6 schools. For schools using a grading system containing 3 or more scores, the percentage of students given the highest grade was significantly less in Surgery (28%) compared with Family Medicine (34%) and Psychiatry (35%) (p = 0.001).
Core clerkship grading systems and the percentage to which institutions grade students as having achieved the highest performance level vary greatly among U.S. medical schools. Within institutions, significant variability exists among clerkships in the percentage of the highest grade given, which makes interpersonal comparison based on core clerkship grades difficult and suggests that this method may not be a reliable indicator of performance.
本研究对使用核心临床实习成绩进行住院医师选拔的合理性提出质疑。作者假设评分系统存在显著差异。
在这项回顾性横断面研究中，研究了三年级核心临床实习评分系统的差异。作者从2004年和2005年申请在其所在科室进行住院医师培训的美国医学院校学生的医学生表现评估中收集了以下变量：医学院校、三年级核心临床实习评分系统以及每个成绩类别的学生百分比。进行了描述性分析，并使用重复测量方差分析（ANOVA）和t检验分析了各实习成绩在机构内部的差异。
大学教学医院。
该调查涵盖了美国医学教育联络委员会（AAMC/LCME）认证的122所美国医学院校中的121所。
使用的评分系统包括：76所学校采用的优等/及格/不及格（H、P、F）系统变体，22所学校采用的字母评分系统，以及其他变体（例如，6所学校采用优秀、进阶和熟练，4所学校采用及格/不及格）。13所学校（10%）未提供评分系统或提供的系统无法解读。所包括的评分系统进一步细分为6所学校为2分制，34所学校为3分制，38所学校为4分制，23所学校为5分制，6所学校为6分制以上。对于使用包含3分或更多分数的评分系统的学校，与家庭医学（34%）和精神病学（35%）相比，外科获得最高分数的学生百分比显著较低（28%）（p = 0.001）。
美国医学院校的核心临床实习评分系统以及机构将学生评为达到最高表现水平的百分比差异很大。在机构内部，各实习中获得最高分数的百分比存在显著差异，这使得基于核心临床实习成绩进行人际比较变得困难，并表明这种方法可能不是表现的可靠指标。
