Which Student Characteristics Are Most Important in Determining Clinical Honors in Clerkships? A Teaching Ward Attending Perspective

How to be a good clerk on the clinical teaching team: a scoping review

Background

As medical institutions shift towards Competency Based Education, more effort is being directed towards understanding how healthcare teams' function competently. While many have studied the competencies required to be a successful clerk, few have examined this question within the context of team function and integration. Our primary objective is to identify how medical clerks successfully integrate and contribute to clinical teaching teams.

Methods

We performed a scoping review of the literature using the Ovid MEDLINE database. Data was extracted and thematically analysed in accordance with Arksey and O'Malley's (2005) approach to descriptive analysis.

Results

Out of 1368 papers returned by our search, 12 studies were included in this review. Seven main themes were identified amongst the included studies: (1) Communication (2) Taking Responsibility and Appropriate Autonomy (3) Humility and Knowing When to Ask for Help (4) Identity as a Team Member, (5) Self-Efficacy (6) Rapport and Relationship Building (7) Patient Advocacy.

Conclusion

Analysis of these themes revealed four major findings: (i) The importance of documentation skills and communication towards team contribution (ii) The important connection between professional identity development and self-efficacy (iii) The impact of rapport on the reciprocity of trust between team members (iv) The role of clerks as patient advocates is poorly understood. This review also illustrates that there is a relative dearth of literature in this area. Future studies are needed to develop clear guidance on how clerks should perform these competencies in the context of team function and integration.

Gender Disparity in Evaluation of Internal Medicine Clerkship Performance

IMPORTANCE

Women studying medicine currently equal men in number, but evidence suggests that men and women might not be evaluated equally throughout their education.

OBJECTIVE

To examine whether there are differences associated with gender in either objective or subjective evaluations of medical students in an internal medicine clerkship.

DESIGN, SETTING, AND PARTICIPANTS

This single-center retrospective cohort study evaluated data from 277 third-year medical students completing internal medicine clerkships in the 2017 to 2018 academic year at an academic hospital and its affiliates in Pennsylvania. Data were analyzed from September to November 2020.

EXPOSURE

Gender, presumed based on pronouns used in evaluations.

MAIN OUTCOMES AND MEASURES

Likert scale evaluations of clinical skills, standardized examination scores, and written evaluations were analyzed. Univariate and multivariate linear regression were used to observe trends in measures. Word embeddings were analyzed for narrative evaluations.

RESULTS

Analyses of 277 third-year medical students completing an internal medicine clerkship (140 women [51%] with a mean [SD] age of 25.5 [2.3] years and 137 [49%] presumed men with a mean [SD] age of 25.9 [2.7] years) detected no difference in final grade distribution. However, women outperformed men in 5 of 8 domains of clinical performance, including patient interaction (difference, 0.07 [95% CI, 0.04-0.13]), growth mindset (difference, 0.08 [95% CI, 0.01-0.11]), communication (difference, 0.05 [95% CI, 0-0.12]), compassion (difference, 0.125 [95% CI, 0.03-0.11]), and professionalism (difference, 0.07 [95% CI, 0-0.11]). With no difference in examination scores or subjective knowledge evaluation, there was a positive correlation between these variables for both genders (women: r = 0.35; men: r = 0.26) but different elevations for the line of best fit (P < .001). Multivariate regression analyses revealed associations between final grade and patient interaction (women: coefficient, 6.64 [95% CI, 2.16-11.12]; P = .004; men: coefficient, 7.11 [95% CI, 2.94-11.28]; P < .001), subjective knowledge evaluation (women: coefficient, 6.66 [95% CI, 3.87-9.45]; P < .001; men: coefficient, 5.45 [95% CI, 2.43-8.43]; P < .001), reported time spent with the student (women: coefficient, 5.35 [95% CI, 2.62-8.08]; P < .001; men: coefficient, 3.65 [95% CI, 0.83-6.47]; P = .01), and communication (women: coefficient, 6.32 [95% CI, 3.12-9.51]; P < .001; men: coefficient, 4.21 [95% CI, 0.92-7.49]; P = .01). The model based on the men's data also included growth mindset as a significant variable (coefficient, 4.09 [95% CI, 0.67-7.50]; P = .02). For narrative evaluations, words in context with "he or him" and "she or her" differed, with agentic terms used in descriptions of men and personality descriptors used more often for women.

CONCLUSIONS AND RELEVANCE

Despite no difference in final grade, women scored higher than men on various domains of clinical performance, and performance in these domains was associated with evaluators' suggested final grade. The content of narrative evaluations significantly differed by student gender. This work supports the hypothesis that how students are evaluated in clinical clerkships is associated with gender.

Are We Measuring What Matters? How Student and Clerkship Characteristics Influence Clinical Grading

PURPOSE

Given the growing emphasis placed on clerkship performance for residency selection, clinical evaluation and its grading implications are critically important; therefore, the authors conducted this study to determine which evaluation components best predict a clinical honors recommendation across 3 core clerkships.

METHOD

Student evaluation data were collected during academic years 2015-2017 from the third-year internal medicine (IM), pediatrics, and surgery clerkships at the University of Alabama at Birmingham School of Medicine. The authors used factor analysis to examine 12 evaluation components (12 items), and they applied multilevel logistic regression to correlate evaluation components with a clinical honors recommendation.

RESULTS

Of 3,947 completed evaluations, 1,508 (38%) recommended clinical honors. The top item that predicted a clinical honors recommendation was clinical reasoning skills for IM (odds ratio [OR] 2.8; 95% confidence interval [CI], 1.9 to 4.2; P < .001), presentation skills for surgery (OR 2.6; 95% CI, 1.6 to 4.2; P < .001), and knowledge application for pediatrics (OR 4.8; 95% CI, 2.8 to 8.2; P < .001). Students who spent more time with their evaluators were more likely to receive clinical honors (P < .001), and residents were more likely than faculty to recommend clinical honors (P < .001). Of the top 5 evaluation items associated with clinical honors, 4 composed a single factor for all clerkships: clinical reasoning, knowledge application, record keeping, and presentation skills.

CONCLUSIONS

The 4 characteristics that best predicted a clinical honors recommendation in all disciplines (clinical reasoning, knowledge application, record keeping, and presentation skills) correspond with traditional definitions of clinical competence. Structural components, such as contact time with evaluators, also correlated with a clinical honors recommendation. These findings provide empiric insight into the determination of clinical honors and the need for heightened attention to structural components of clerkships and increased scrutiny of evaluation rubrics.