Grading

After the completion a committee comprised of the clerkship directors and course administrator will meet to discuss the performance of all students during the clerkship. The committee will discuss student performance relative to grading criteria, any issues of professionalism noted during the block, and any exceptional circumstances that may have impacted student performance in a particular area. Students will be graded against a criterion-based standard. Attending evaluations are normalized to remove any tendency of the attending to grade easy or hard.

Professionalism & Grades: Various degrees of loss of professionalism points will put the student out of consideration of certain grade categories. For Honors (max 0 points lost); for High Pass (allowed 0-1 points lost); Pass (allowed 2-3 points lost); Fail (>3 points lost).

Per the Curriculum Committee, as of the 2018-2019 academic year, the clinical evaluation of student underwent a format change from a 10-item Likert scale to a 4-item scale: “Did not meet expectations” (DNM); “Meets Expectations” (ME); “Exceeds Expectation” (EE); or N/A.

For the Internal Medicine Clerkship, the transition from the previous evaluation system to the current one will be integrated into the grading system as follows:

Eligibility for Honors*: ≥ 50% EE AND 0 DNM
Eligibility for HP*: ≥ 20% EE AND < 2 DNM
Eligibility for Pass*: < 20% EE AND < 5 DNM

To be eligible for consideration for Honors/High Pass/Pass, the student is expected to meet the following criteria:

Honors criteria	High Pass criteria	Pass criteria
Ward Evaluations (H): ≥ 50% of categories rated as Exceeds Expectations; Meets Expectations in the remainder of the categories AND 0 Did Not Meet ratings* No (0) points lost on Professionalism. Score ≥ 94% on the Practical Exam Score ≥ 80th percentile nationally on the shelf exam. Score ≥ 93% on the overall SP encounter Complete and turn in all grade sheets on time. Have no unexcused absences.	Ward Evaluations (HP): ≥ 20% of categories rated as Exceeds Expectations; Meets Expectations in the remainder of the categories AND < 2 Did Not Meet ratings* No more than 1 point lost on Professionalism. Score ≥ 88% on the Practical Exam Score ≥ 50th percentile nationally on the shelf exam. Score ≥ 85% on the overall SP encounter Complete and turn in all required assignments on time. Have no unexcused absences.	Ward Evaluations (P): Meets Expectations in most categories, with fewer than 20% that are Exceeds Expectations AND < 5 Did Not Meet ratings* No more than 3 points lost on Professionalism. Score ≥70% on the Practical exam. Score ≥5th percentile nationally on the shelf exam. Score ≥ 75% on the overall SP encounter Complete and turn in all required assignments on time. Have no unexcused absences.

*Note:

The cutoffs for the ratios above were extrapolated from the IM clerkship cutoffs under the previous evaluation system. While no adjustments in the near future are planned; it is possible that some fine-tuning will be required. If this occurs, we will re-calculate your evaluation score using any new cutoffs. If this recalculation affects your clerkship grade, we will notify you and submit a grade change form. This was mutually agreed upon by all of the clerkship directors at the curriculum committee meeting.

Practical Exam – this will take place during the last week of the clerkship.

This exam will be comprised of two parts a) an online portion on interpreting EKGs, reading chest radiographs, and b) a clinical problem solving short answer exam. More info about the Practical Exam is available here.

NBME Shelf Exam - this will take place on the last Friday of the clerkship.

This exam is comprised of approximately 110 multiple-choice questions made by the NBME (National Board of Medical Examiners). To pass the clerkship you MUST score above the 5th percentile. Scoring below this percentile will result in a condition grade for the clerkship and you will have to retake the exam. The NBME Clinical Science Medicine content outline can be found here: NBME-Medicine-Shelf

Clinics

Only attendance at clinics will be assessed; this will be via clinic signatures as described on the IM Clinics Page. Incomplete signatures will result in loss of Professionalism points.

Ward Evaluations

Most students will have 3 total evaluations for the 8 weeks. The attendings, residents, and interns should evaluate each student and complete a consensus evaluation. For subspecialty service, fellow evaluations may be used. Students will be evaluated on the following 6 categories (ACGME Core Competencies): Patient Care, Knowledge for Practice, Practice-Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, Systems-Based Practice.

Borderline Grades

For any students who are just below the criteria for a better grade, the clerkship committee will evaluate the overall score and student’s performance in detail as described above. Benefit of the doubt may be given for students with exceptional performance on the wards. The shelf exam will not trump poor ward performance no matter how excellent the shelf score. A poor Professionalism grade automatically removes the student from consideration for the higher grade.

FAILURES

If a student fails a ward evaluation, the clerkship committee will evaluate his or her clerkship performance. Unless there is substantial evidence to refute the ward evaluations, there are two possible outcomes:

Depending on the degree of failure, the student may receive a CONDITION GRADE and need to repeat a month of wards to receive a passing grade.
If the degree of failure is egregious or severe, the student will fail and need to repeat the entire clerkship.

Otherwise:

Failure of the practical exam will result in the student repeating the exam until the student passes.
Failure of the NBME exam requires the student to retake the exam and if a passing score is achieved, earn at most a CONDITIONAL PASS. If the student fails the NBME exam a second time, he or she will need to repeat the entire clerkship as described in the student handbook.