Wednesday, March 6, 2013

Grade Inflation in the Internal Medicine Clerkship- The Lake Wobegon Effect

During my tenure as the Internal Medicine Clerkship Director at Virginia Commonwealth University, we developed a grading process that mitigated grade inflation.  

For an honors or high pass grade, students had to meet certain standards across various metrics including ward evaluations, observed structured clinical examinations (OSCEs), team-based learning exams (TBL) and the written examination. In the end, an honors student was globally excellent across all performance metrics. 

The result: the proportion of Honors students went from 50% to 15%-20%. Despite the criticisms, our students fared exceptionally well in the national residency match program. 

Here is an article recently published on grade inflation in the internal medicine clerkships across the USA. A majority of clerkship directors reported that grade inflation still exists. More concerning, howoever, many noted students who passed despite the clerkship director believing they should have failed.

Here is a corresponding article in the New York Times that explores how failing medical students do not receive failing grades.

Call it the Lake Wobegon Effect of medical school, where every medical student is above average. 

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