J.L. Hanson is professor of medicine, director of education scholarship development, and codirector, Medical Education Research Unit, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: http://orcid.org/0000-0001-7051-8225 .
M. Pérez is a clinical research specialist, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-2809-2504 .
Acad Med. 2022 Nov 1;97(11S):S35-S45. doi: 10.1097/ACM.0000000000004914. Epub 2022 Aug 9.
Racial/ethnic disparities exist in clinical clerkship grading, yet little is known about medical student and faculty perspectives on why these disparities occur. This study explored what happens during clerkships that might explain grading disparities.
Medical students and clerkship teachers at 3 U.S. medical schools completed a demographic survey and semistructured interview. The constant comparative method was used to analyze transcripts by inductively developing codes; grouping codes in categories; and refining codes, descriptions, and group assignments to identify themes. Interpretations of and relationships among themes were iteratively discussed to develop a grounded theory.
Fifty-nine participants (29 medical students, 30 teachers [28 clinical faculty, 2 residents]) were interviewed in 2020. The Social Milieu of Medical Education (relationships, fit, opportunities, and judgments in the clinical-learning setting) was the organizing theme, influenced by 5 additional themes: Societal Influence (experiences in society), Students' Characteristics and Background (personal characteristics and experiences outside medical school), Assessment Processes (collection of student performance data and how data inform grades), Learning Environment (resources available and messaging within the clinical setting), and Students' Interactions and Reactions (interactions with and reactions to peers and teachers). The grounded theory highlights complex, multilayered aspects of how the social milieu of medical education is shaped by and shapes students' experiences, relationships, and clerkship assessments and promotes clerkship-grading disparities.
Mitigating clerkship-grading disparities will require intervening on interrelated, contextual factors to provide equitable opportunities for students from diverse backgrounds and with varying styles of engagement in clinical-learning settings, along with attending to modifying assessment processes.
临床实习评分存在种族/民族差异，但对于医学生和教师对这些差异产生原因的看法知之甚少。本研究探讨了在实习期间可能导致评分差异的情况。
3 所美国医学院的医学生和实习教师完成了人口统计调查和半结构化访谈。采用恒定性比较方法，通过归纳式发展代码对转录本进行分析；将代码分组到类别中；并细化代码、描述和分组，以确定主题。通过反复讨论对主题的解释和关系，发展出一个扎根理论。
2020 年，共有 59 名参与者（29 名医学生，30 名教师[28 名临床教师，2 名住院医师]）接受了采访。医学教育的社会环境（临床学习环境中的关系、契合度、机会和判断）是组织主题，受 5 个附加主题的影响：社会影响（社会经历）、学生的特点和背景（医学之外的个人特点和经历）、评估过程（收集学生表现数据以及数据如何影响成绩）、学习环境（临床环境中可用的资源和信息）以及学生的互动和反应（与同伴和教师的互动以及对其的反应）。该扎根理论强调了医学教育的社会环境是如何通过塑造学生的经历、关系以及实习评估来影响和塑造学生的经历、关系以及实习评估，并促进实习评分差异的复杂、多层次方面。
要缓解实习评分差异，需要干预相互关联的背景因素，为来自不同背景和具有不同临床学习环境参与风格的学生提供公平的机会，并注意修改评估过程。
