title: Re-demonstration without remediation--a missed opportunity? A national survey of internal medicine clerkship directors.
abstract: BACKGROUND
  Many different components factor into the final grade assigned for the internal medicine clerkship. Failure of one or more of these requires consideration of remedial measures.
  
  
  OBJECTIVE
  To determine which assessment components are used to assign students a passing grade for the clerkship and what remediation measures are required when students do not pass a component.
  
  
  METHODS
  A national cross-sectional survey of Clerkship Directors in Internal Medicine (CDIM) institutional members was conducted in April 2011. The survey included sections on remediation, grading practices, and demographics. The authors analyzed responses using descriptive and comparative statistics.
  
  
  RESULTS
  Response rate was 73% (86/113). Medicine clerkships required students to pass the following components: clinical evaluations 83 (97%), NBME subject exam 76 (88%), written assignments 40 (46%), OSCE 35 (41%), in-house written exam 23 (27%), and mini-CEX 19 (22%). When students failed a component of the clerkship for the first time, 55 schools (64%) simply allowed students to make up the component, while only 16 (18%) allowed a simple make-up for a second failure. Additional ward time was required by 24 schools (28%) for a first-time failure of one component of the clerkship and by 49 (57%) for a second failure. The presence or absence of true remedial measures in a school was not associated with clerkship director academic rank, grading scheme, or percent of students who failed the clerkship in the previous year.
  
  
  CONCLUSIONS
  Most schools required passing clinical evaluations and NBME subject exam components to pass the medicine clerkship, but there was variability in other requirements. Most schools allowed students to simply re-take the component for a first-time failure. This study raises the question of whether true remediation is being undertaken before students are asked to re-demonstrate competence in a failed area of the clerkship to be ready for the subinternship level.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Mary.Hawthorne@umassmemorial.org.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Hawthorne
authors.affiliation: Department of Medicine, George Washington University, Washington, DC, USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Chretien
authors.affiliation: Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Dario
authors.initials: D
authors.lastname: Torre
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Shobhina G
authors.initials: SG
authors.lastname: Chheda
mesh_terms: D002170:Canada; D002982:Clinical Clerkship; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D012577:Schools, Medical; D011795:Surveys and Questionnaires; D014481:United States
keywords: clerkship; clerkship failure; clinical competence; evaluation; failure; grade; medical knowledge; remediation