Evaluation and Grading
We compare current students against students completing the Clerkship at the same time of the year, over the past three years. This eliminates the need to curve individual cohorts. This approach is based on the fact that students over the past three years have had the same experience as those currently on the Clerkship.
Your grade on the Internal Medicine Clerkship is based on your clinical performance and your score on the written examination, which is administered at the end of the clerkship. We use the Subject Examination in Internal Medicine of the USMLE, Step 2. Your score is normalized against national standards (mean 70, standard deviation 8), and your performance is weighted at 33% of the grade. You must score at least 65 in order to pass the clerkship.
Each of your two clinical rotations accounts for 33% of your grade. On the general inpatient service, your average attending evaluation counts for half of the score, and your average evaluation by housestaff counts for half of the score for that rotation.
On AIM, you will not work with housestaff, and so your entire clinical evaluation is based on the score provided by your preceptor(s). If you are evaluated by more than one physician, the scores are weighted by your amount of contact with each evaluator. These clinical evaluations count for 75% of the AIM grade. 15% of your grade is based on an evaluation of your performance in the workshop sessions, and 10% of your grade is based on an evaluation of the case study that you will prepare as part of the AIM experience.
Calculation of grades: The Department of Medicine calculates grades using sliding break-points which adjust upward for each period. These break-points are based on the performance of the preceding three classes during the same period and are predicted to yield approximately 30% A-range grades in each quarter. Any student whose score surpasses a break point will receive that grade, and it is thus theoretically possible that an entire clerkship cohort could receive A-range grades. Unlike a system where each cohort is individually curved, our grading system means that students in a particular cohort are not at all directly competing with one another. On the other hand, it means that if your class performs significantly differently from last year's class, the distribution of grades might be different from that predicted.
Grading scale: We use a nine-point grading scale. The nine-point scale is favored by the American College of Physicians and by the NBME. They note that with inflation of subjective elevations, it is useful to have three or four grade levels in the top half of the scale, so that one can still differentiate among good students.
Passing the Clerkship in Internal Medicine requires that one obtain an overall weighted score of 6.0 or higher and a scaled score of at least 65 on the Subject Examination in Internal Medicine administered at the end of the clerkship. Students with adequate clinical performance but failing the written examination may be asked to repeat the examination and obtain a passing score. Students with unsatisfactory clinical performances may be asked to do additional ward work.
Concerns: Concerns about grades can be taken up with Dr. Tucker by individual appointment. Under no circumstances should students directly contact faculty or housestaff regarding grades.