title: Grade Inflation in Medical Student Radiation Oncology Clerkships: Missed Opportunities for Feedback?
abstract: OBJECTIVE
  To test the hypothesis that medical student radiation oncology elective rotation grades are inflated and cannot be used to distinguish residency applicants.
  
  
  METHODS
  The records of 196 applicants to a single radiation oncology residency program in 2011 and 2012 were retrospectively reviewed. The grades for each rotation in radiation oncology were collected and converted to a standardized 4-point grading scale (honors, high pass, pass, fail). Pass/fail grades were scored as not applicable. The primary study endpoint was to compare the distribution of applicants' grades in radiation oncology with their grades in medicine, surgery, pediatrics, and obstetrics/gynecology core clerkships.
  
  
  RESULTS
  The mean United States Medical Licensing Examination Step 1 score of the applicants was 237 (range, 188-269), 43% had additional Masters or PhD degrees, and 74% had at least 1 publication. Twenty-nine applicants were graded for radiation oncology rotations on a pass/fail basis and were excluded from the final analysis. Of the remaining applicants (n=167), 80% received the highest possible grade for their radiation oncology rotations. Grades in radiation oncology were significantly higher than each of the other 4 clerkships studied (P<.001). Of all applicants, 195 of 196 matched into a radiation oncology residency. Higher grades in radiation oncology were associated with significantly higher grades in the pediatrics core clerkship (P=.002). However, other medical school performance metrics were not significantly associated with higher grades in radiation oncology.
  
  
  CONCLUSIONS
  Although our study group consists of a selected group of radiation oncology applicants, their grades in radiation oncology clerkships were highly skewed toward the highest grades when compared with grades in other core clerkships. Student grading in radiation oncology clerkships should be re-evaluated to incorporate more objective and detailed performance metrics to allow for meaningful feedback to trainees and to better evaluate residency applicants to radiation oncology.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: surbhi.grover@uphs.upenn.edu.
authors.forename: Surbhi
authors.initials: S
authors.lastname: Grover
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Stasha
authors.initials: S
authors.lastname: Sosnowicz
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Abigail T
authors.initials: AT
authors.lastname: Berman
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Cordelia
authors.initials: C
authors.lastname: Baffic
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Freedman
mesh_terms: D000124:Achievement; D000328:Adult; D002982:Clinical Clerkship / Q000592:standards*; D004521:Educational Measurement / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000193:education / Q000592:standards; D006176:Gynecology / Q000193:education / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000193:education / Q000592:standards; D010372:Pediatrics / Q000193:education / Q000592:standards; D018787:Radiation Oncology / Q000193:education* / Q000592:standards; D012016:Reference Values; D012570:School Admission Criteria; D016008:Statistical Distributions; D013337:Students, Medical; D055815:Young Adult