D.C. Schilling is associate professor and psychiatry clerkship director, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois; ORCID: http://orcid/000-0001-8553-6186.
Acad Med. 2019 Mar;94(3):328-332. doi: 10.1097/ACM.0000000000002438.
Most clerkships require medical students to pass the National Board of Medical Examiners (NBME) subject (shelf) exam to pass the clerkship. Many use the NBME's recommended honors cut score on the shelf exam to determine medical student eligibility for an overall clerkship grade of honors. This use of a conjunctive scoring model for determining honors is inconsistent with the logic behind the intended use of this model for making pass-fail determinations. Further, many clerkships use grading systems that employ both this conjunctive model for honors eligibility and a compensatory scoring model for determining the overall clerkship grade. For students who fall short of the shelf exam honors cut score, such a grading system effectively increases the weighting of shelf exam performance and decreases the clerkship's transparency about the weighting of performance on other assessments toward the clerkship composite score and overall grade. It may also lead to contradictory grading results in which student B has a higher composite score than student A, yet student B receives a lower overall grade. The author illustrates how to calculate a weight for shelf exam performance that would be fairer to students and would help create a more transparent weighting scheme for the grading system. The author recommends that clerkships restructure their grading systems so that shelf exam honors-eligibility cut scores are not used as conjunctive criteria for determining overall clerkship grades of honors. A reexamination of the NBME's practice of suggesting honors-eligibility cut scores for shelf exams is also recommended.
大多数实习要求医学生通过美国医师执照考试委员会（NBME）的科目（壁橱）考试才能通过实习。许多人使用 NBME 推荐的壁橱考试荣誉分数切点来确定医学生是否有资格获得整体实习荣誉等级。这种使用连接评分模型来确定荣誉的方法与该模型用于做出通过/失败决定的逻辑不一致。此外，许多实习采用评分系统，既使用该连接模型来确定荣誉资格，又使用补偿评分模型来确定整体实习成绩。对于未能达到壁橱考试荣誉分数切点的学生，这种评分系统实际上增加了壁橱考试成绩的权重，降低了实习对其他评估成绩在实习综合成绩和整体成绩中的权重的透明度。它还可能导致矛盾的评分结果，即学生 B 的综合成绩高于学生 A，但学生 B 的整体成绩较低。作者说明了如何计算壁橱考试成绩的权重，这对学生更公平，并有助于为评分系统创建更透明的权重方案。作者建议实习重新构建其评分系统，以便壁橱考试的荣誉资格分数切点不再作为确定整体实习荣誉等级的连接标准。还建议重新审查 NBME 为壁橱考试建议荣誉资格分数切点的做法。
