Evaluating clerkship competency without exams.

Area of Science:

• Medical Education
• Clinical Assessment
• Competency-Based Education

Background:

• Current clerkship grading relies on examination scores, potentially hindering student engagement during critical clinical immersion.
• Student performance narratives from preceptors offer an alternative for assessing competence but lack validation against examination data.

Purpose of the Study:

• To investigate the alignment between student performance narratives and examination scores in internal medicine clerkships.
• To explore patterns in preceptor comments for high- and low-scoring students.

Main Methods:

• Retrospective analysis of performance data from five cohorts of internal medicine clerkship students.
• Correlation of end-of-rotation examination scores with narrative-based competency ratings.
• Exploration of narrative patterns differentiating high- and low-scoring students.

Main Results:

• Narrative-based competency ratings showed correlation with examination scores.
• Lowest-scoring students received fewer overall comments and more recommendations for improvement.
• Recommendations for low-scoring students addressed knowledge, clinical skills, and professionalism equally; high-scoring students' recommendations favored knowledge and clinical skills.

Conclusions:

• Preceptor performance narratives can support competency judgments based on workplace learning and correlate with independent assessments.
• Utilizing performance narratives for grading may offer a balanced approach to learning and assessment in core clerkship rotations.