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Which Student Characteristics Are Most Important in Determining Clinical Honors in Clerkships? A Teaching Ward
Lauren Nicholas Herrera1, Ryan Khodadadi, Erinn Schmit
1L.N. Herrera is a second-year internal medicine resident, Department of Medicine, Baylor College of Medicine, Houston, Texas. The author was a fourth-year medical student, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, at the time of the study. R. Khodadadi is a second-year internal medicine resident, Department of Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota. The author was a fourth-year medical student, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, at the time of the study. E. Schmit is a fellow, Pediatric Hospital Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama. J. Willig is associate professor of medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. A. Hoellein is associate dean for student affairs and associate professor of medicine, University of Kentucky College of Medicine, Lexington, Kentucky. C. Knudson is staff physician, Emory University Hospital Midtown, and assistant professor of medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia. K. Law is program director, J. Willis Hurst Internal Medicine Residency Program, Emory University, and associate vice chair of education and associate professor of medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia. N. Mingioni is staff physician, Thomas Jefferson University Hospital, and clinical associate professor of medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. K. Walsh is assistant professor of clinical internal medicine, Division of Hematology and Department of Medicine, The Ohio State University, Columbus, Ohio. C. Estrada is staff physician, Birmingham Veterans Affairs Medical Center, and professor of medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. W. Williams is clerkship codirector and assistant professor of medicine, Department of Medicine, University of Alabama at Birmingham, and staff physician, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.
Purpose:
To explore faculty perspectives on which characteristics of high-performing clerkship students are most important when determining an honors or top grade designation for clinical performance.
Method:
In 2016-2017, the authors surveyed faculty (teaching ward attendings) for internal medicine clerkships and 1 pediatrics clerkship in inpatient settings at 5 U.S. academic medical centers. Survey items were framed around competencies, 24 student characteristics, and attitudes toward evaluation. Factor analysis examined constructs defining high-performing students.
Results:
Of 516 faculty invited, 319 (62%) responded. The top 5 characteristics as rated by respondents were taking ownership, clinical reasoning, curiosity, dependability, and high ethical standards (in descending order). Twenty-one characteristics fit into 3 factors (Cronbach alpha, 0.81-0.87). Clinical reasoning did not fit into a factor. Factor 1 was the most important (mean rating, 8.7/10 [95% confidence interval (CI), 8.6-8.8]). It included professionalism components (ownership, curiosity, dependability, high ethical standards), presentation and interviewing skills, seeking feedback, and documentation. Factor 2 (mean, 7.9 [95% CI, 7.7-8.0]) included aspects of teamwork and communication, such as positive attitude and comments from others. Factor 3 (mean, 7.6 [95% CI, 7.4-7.7]) addressed systems-based thinking, including patient safety and care transitions.
Conclusions:
Professionalism components, clinical reasoning, and curiosity were among the most important characteristics distinguishing high-performing clerkship students. These may represent behaviors that are highly valued, observable, and relevant to training stage. Improved definition of the characteristics associated with clinical honors would assist students, faculty, and residency program directors when interpreting clinical performance within core clerkships.
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