J.L. Bullock is a first-year resident in internal medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California. The author was a fourth-year medical student at the time of writing. C.J. Lai is director of internal medicine clerkships and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California. T. Lockspeiser is director of the assessment/competency committee and associate professor, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. P.S. O'Sullivan is director of research and development in medical education and professor, Department of Medicine and Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, California. P. Aronowitz is clerkship director of internal medicine and professor, Department of Internal Medicine, University of California, Davis School of Medicine, Davis, California. D. Dellmore is director of medical student education and associate professor, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico. C.-C. Fung is assistant dean for medical education and associate professor, Keck School of Medicine of USC, Los Angeles, California. C. Knight is associate clerkship director and associate professor, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington. K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California.
Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S48-S56. doi: 10.1097/ACM.0000000000002905.
To examine medical students' perceptions of the fairness and accuracy of core clerkship assessment, the clerkship learning environment, and contributors to students' achievement.
Fourth-year medical students at 6 institutions completed a survey in 2018 assessing perceptions of the fairness and accuracy of clerkship evaluation and grading, the learning environment including clerkship goal structures (mastery- or performance-oriented), racial/ethnic stereotype threat, and student performance (honors earned). Factor analysis of 5-point Likert items (1 = strongly disagree, 5 = strongly agree) provided scale scores of perceptions. Using multivariable regression, investigators examined predictors of honors earned. Qualitative content analysis of responses to an open-ended question yielded students' recommendations to improve clerkship grading.
Overall response rate was 71.1% (666/937). Students believed that being liked and particular supervisors most influenced final grades. Only 44.4% agreed that grading was fair. Students felt the clerkship learning environment promoted both mastery and performance avoidance behaviors (88.0% and 85.6%, respectively). Students from backgrounds underrepresented in medicine were more likely to experience stereotype threat vulnerability (55.7% vs 10.9%, P < .0005). Honors earned was positively associated with perceived accuracy of grading and interest in competitive specialties while negatively associated with stereotype threat. Students recommended strategies to improve clerkship grading: eliminating honors, training evaluators, and rewarding improvement on clerkships.
Participants had concerns around the fairness and accuracy of clerkship evaluation and grading and potential bias. Students expressed a need to redefine the culture of assessment on core clerkships to create more favorable learning environments for all students.
调查医学生对核心科室评估的公平性和准确性、科室学习环境以及学生成绩影响因素的看法。
2018 年，6 所机构的四年级医学生完成了一项调查，评估他们对科室评估和评分的公平性和准确性、学习环境（包括科室目标结构（掌握导向或表现导向）、种族/民族刻板印象威胁以及学生表现（获得荣誉）的看法。对 5 分李克特量表（1=非常不同意，5=非常同意）的项目进行因子分析，得出对感知的评分。采用多变量回归分析，研究人员考察了获得荣誉的预测因素。对一个开放式问题的定性内容分析得出了学生对改善科室评分的建议。
总体回复率为 71.1%（666/937）。学生认为受喜欢和特定导师的影响最大。只有 44.4%的人同意评分公平。学生认为科室学习环境促进了掌握和表现回避行为（分别为 88.0%和 85.6%）。来自医学领域代表性不足背景的学生更有可能经历刻板印象威胁脆弱性（55.7%比 10.9%，P<0.0005）。获得荣誉与感知评分准确性和对竞争专业的兴趣呈正相关，与刻板印象威胁呈负相关。学生建议了改善科室评分的策略：取消荣誉、培训评估者以及奖励科室表现的改善。
参与者对科室评估和评分的公平性和准确性以及潜在偏见表示担忧。学生表示需要重新定义核心科室评估文化，为所有学生创造更有利的学习环境。
