What is the "ideal" grading system for the junior surgery clerkship?

There is currently no consistency in grading systems for clinical clerkships across medical schools.

Surgery clerkship directors were surveyed regarding their current grading categories, distribution of grades across levels, and opinions about the "ideal" grading system.

Responses were received from 103 of 134 schools (77%). The following grading systems were employed: numerical scores, 1%; points, 1%; pass/fail, 5%; letter grades, 19%; and descriptor terms, 74%. Institutions used the following number of grading categories: 2, 5%; 3, 18%; 4, 35%; 5, 37%; 6, 3%; and 7, 1%. There was considerable variation between schools in frequency distributions across levels. Half of clerkship directors were satisfied with their system, and most considered an ideal system to consist of 4 or 5 descriptors.

We believe an optimal clerkship grading system should consist of 4 or 5 categories. A 3-level system does not sufficiently discriminate, and with more than 5 categories the lowest levels are rarely used. Grades must be reported with clear information about their significance in each institution.