title: Beyond the Ivory Tower: A Comparison of Grades Across Academic and Community OB/GYN Clerkship Sites.
abstract: CONSTRUCT: Decentralized clinical education is the use of community facilities and community physicians to educate medical students. The theory behind decentralized clinical education is that academic and community sites will provide educational equivalency as determined by objective and subjective performance measures, while training more medical students and exposing students to rural or underserved communities. One of the major challenges of decentralized clinical education is ensuring site comparability in both learning opportunities and evaluation of students.
  
  
  BACKGROUND
  Previous research has examined objective measures of student performance, but less is known about subjective performance measures, particularly in the field of obstetrics and gynecology (OB/GYN). This study explores the implications of clinical site on the adequacy of subjective and objective performance measures.
  
  
  METHODS
  This was a retrospective cohort study of 801 students in the University of Washington School of Medicine OB/GYN clerkship from 2008 to 2012. Academic sites included those with OB/GYN residency programs (n = 2) and community sites included those without residency programs (n = 29). The association between clerkship site and National Board of Medical Examiners (NBME) grade was assessed using linear regression and clinical and final grade using multinomial regression, estimating β coefficient and relative risks (RR), respectively, and 95% confidence intervals (CIs), adjusting for gender, academic quarter of clerkship, and year of clerkship.
  
  
  RESULTS
  There were no differences in NBME exam grades of students at academic sites (76.4 (7.3) versus 74.6 (8.0), β = -0.11, 95% CI [1.35, 1.12] compared to community sites. For clinical grade, students at community sites were 2.4 times more likely to receive honors relative to high pass (RR 2.45), 95% CI [1.72, 3.50], and for final grade, students at community sites were 1.9 times more likely to receive honors relative to pass (RR 1.98), 95% CI [1.27, 3.09], and 1.6 times more likely to receive honors relative to high pass (RR 1.62), 95% CI [1.05, 2.50], compared to those at academic sites.
  
  
  CONCLUSIONS
  Students at community sites receive higher clinical and final grades in the OB/GYN clerkship. This highlights a significant challenge in decentralized clinical education-ensuring site comparability in clinical grading, Further work should examine the differences in sites, as well as improve standardization of clinical grading. This also underscores an important consideration, as the final grade can influence medical school rank, nomination into honor societies, and ranking of residency applicants.
authors.affiliation: a Department of Obstetrics and Gynecology , University of Washington School of Medicine , Seattle , Washington , USA.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Fay
authors.affiliation: a Department of Obstetrics and Gynecology , University of Washington School of Medicine , Seattle , Washington , USA.|b Department of Epidemiology , University of Washington School of Public Health , Seattle , Washington , USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Schiff
authors.affiliation: a Department of Obstetrics and Gynecology , University of Washington School of Medicine , Seattle , Washington , USA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Mendiratta
authors.affiliation: a Department of Obstetrics and Gynecology , University of Washington School of Medicine , Seattle , Washington , USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Benedetti
authors.affiliation: a Department of Obstetrics and Gynecology , University of Washington School of Medicine , Seattle , Washington , USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Debiec
mesh_terms: D000328:Adult; D002982:Clinical Clerkship; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D008297:Male; D009774:Obstetrics / Q000193:education*; D012189:Retrospective Studies; D014861:Washington
keywords: clinical education; decentralized education; medical education; obstetrics and gynecology