Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey.

Abstract

Clerkship grades are important in the residency selection process but can be influenced by individual bias and grading tendencies. Although clinical competency committees are standard in graduate medical education, in undergraduate medical education, they have not gained widespread traction. This study describes structures and processes of grading committees in internal medicine (IM) clerkships and strategies used to mitigate grading bias. From September to December 2022, the Clerkship Directors in Internal Medicine conducted its annual survey of IM core clerkship directors at 140 U.S. and U.S. territory-based medical schools. This study was based on 23 questions about grading committees in IM clerkships. The survey response rate was 80% (n = 112/140). Forty-seven respondents (42%) reported using grading committees in their IM clerkship (median committee size, 7; range, 3-20) (primarily clerkship leadership and faculty). Responsibilities included determining grades for all students (31 [66%]) and students at borderline of failing (30 [64%]), adjudicating on students with professionalism concerns (25 [53%]), and reconciling discordant clinical evaluations (24 [51%]). To mitigate deliberation bias, committees most frequently used multisource assessments (38 [81%]) and adoption of a shared mental model (36 [77%]). Approximately one-third of grading committees "rarely" discussed gender (14 [30%]) and race or ethnicity (15 [32%]), and 7 committees (15%) "never" discussed gender and race or ethnicity. Clerkship directors perceived developing a shared mental model (60 [92%]), promoting consistency (59 [91%]) and transparency (57 [88%]) in the process, mitigating assessment bias (58 [89%]), improving student satisfaction (54 [83%]), and sharing grading responsibility (44 [68%]) as potential benefits. This study found that grading committees in IM clerkships are not widely used and that existing committees vary in structure and process. These findings highlight an opportunity for medical schools to consider using grading committees to improve grade assignment and address grading inconsistencies.