An approach to address grade inflation in a psychiatry clerkship

Universally, clerkship grading is diverse and not standardized. The authors' faculty was troubled by the inability to provide meaningful evaluations, as more than 60% of students received the highest grade. Although a psychiatry clerkship mandate of a faculty-observed student clinical interview existed for several years, the majority of students reported not completing the interview under direct observation by a faculty member, and no meaningful feedback or evaluation for this activity existed. In order to create diversity in grading criteria and to examine clinical skills more thoroughly than previously, written and oral examinations were developed and supervised interviews of patients and written comprehensive psychiatric evaluations were added. A core group of department faculty was instructed in the use of materials and instruments designed to standardize the experiences and the student evaluations.

Adding a wider diversity of experiences and evaluations to the clerkship, particularly assessment of interviewing skills, oral exams, and evaluation of comprehensive histories, has resulted in a more divergent spread of grades.

Clerkship grades can be effectively computed using various methods to examine knowledge and clinical skills. The addition of new methods of evaluation has added specificity to the performance feedback provided to the students completing the psychiatric clerkship. These changes have been viewed positively by department faculty and medical students. While requiring further refinement, they may eventually provide data to identify students requiring special attention in specific cognitive, relational, and clinical skill areas.