Medical student performance evaluation narrative assessment composition processes and challenges: a national survey...

Residency selection processes have become increasingly time intensive and complex. This study examined current processes and barriers to the creation and composition of internal medicine clerkship narrative assessments to inform potential improvement opportunities.

Internal medicine clerkship directors (CDs) at US Liaison Committee on Medical Education-accredited medical schools with membership in an academic medicine professional association completed a multithemed annual survey between September 7, 2022 and December 6, 2022. The survey explored faculty development for composing narrative assessments, translation of assessments to the Medical Student Performance Evaluation (MSPE) narrative, and practices for editing MSPE evaluations.

Of the 140 CDs sent the survey, 112 responded (response rate, 80.0%). Two CDs who did not complete the entire survey completed this study's section (section response rate, 81.4%). The frameworks reported to assess clinical -performance included Accreditation Council for Graduate Medical Education core competencies (84 [73.7%]), Reporter-Interpreter-Manager-Educator (51 [44.7%]), and Entrustable Professional Activities (49 [43.0%]). Fifty-seven CDs (50.0%) review and interpret preceptor comments, 65 (57.1%) select portions of faculty assessments or representative comments, and 24 (21.1%) copy and paste all faculty narrative comments. Most respondents reported that narrative comments described clinical skills to a moderate (60 [52.6%]) or great (52 [45.6%]) extent. CDs identified assessments that primarily describe teamwork and personal attributes or use code words and global adjectives instead of providing descriptions of observable clinical skills. No associations with school size or grading scheme were identified in a subgroup analysis.

Although responsibility for the end-of-clerkship narrative evaluation belongs mostly to CDs, the processes for creating range from synthesis to administrative copy-paste. Although largely reliant on faculty narrative assessments, CDs reconfirmed inconsistent quality and continued to perceive barriers to faculty development for improvement. Understanding these process similarities, differences, and stressors will help identify opportunities and needs for future improvement -efforts.