Bringing clerkship grading back to the bedside

Area of Science:

• Medical Education
• Competency-Based Assessment

Background:

• Traditional medical education emphasizes bedside learning but grading systems often prioritize knowledge exams over patient care skills.
• Existing grading structures may inadvertently discourage direct patient interaction and holistic skill development.

Purpose of the Study:

• To innovate medical school grading by developing a system that recognizes competencies beyond medical knowledge.
• To encourage the development of patient care, communication, and professionalism skills.

Main Methods:

• A competency-based criterion system was developed for four domains: patient care, medical knowledge, professionalism, and communication/teamwork.
• Students received designations of inadequate, competent, or exemplary in each domain.
• Honors were awarded for exemplary performance in at least two domains, utilizing a primarily compensatory model.

Main Results:

• The revised system saw a significant increase in students receiving honors (40% vs. 15%).
• A notable percentage of honors (43%) were awarded to students who did not achieve exemplary scores in the medical knowledge examination.
• The grading reform successfully broadened the criteria for academic recognition.

Conclusions:

• The revised grading system effectively recognizes diverse student excellence in clinical clerkships.
• It allows for the acknowledgment of high achievement in patient care and related skills beyond standardized testing.
• This model promotes a more comprehensive evaluation of medical trainees.