title: Grading Practices and Distributions Across Internal Medicine Clerkships.
abstract: BACKGROUND
  Clerkship evaluation and grading practices vary widely between U.S. medical schools. Grade inflation continues to exist, and grade distribution is likely to be different among U.S. medical schools.
  
  
  OBJECTIVE
  Increasing the number of available grades curtails "grade inflation."
  
  
  METHODS
  A national survey of all Clerkship Directors in Internal Medicine members was administered in 2011. The authors assessed key aspects of grading.
  
  
  RESULTS
  Response rate was 76%. Among clerkship directors (CDs), 61% of respondents agreed that grade inflation existed in the internal medicine clerkship at their school, and 43% believed that it helped students obtain better residency positions. With respect to grading practices, 79% of CDs define specific behaviors needed to achieve each grade, and 36% specify an ideal grade distribution. In addition, 44% have a trained core faculty responsible for evaluating students, 35% describe formal grading meetings, and 39% use the Reporter-Interpreter-Manager-Educator (RIME) scheme. Grading scales were described as follows: 4% utilize a pass/fail system, 13% a 3-tier (e.g., Honors/Pass/Fail), 45% 4-tier, 35% 5-tier, and 4% 6+-tier system. There was a trend to higher grades with more tiers available.
  
  
  CONCLUSIONS
  Grade inflation continues in the internal medicine clerkship. Almost half of CDs feel that this practice assists students to obtain better residency positions. A minority of programs have a trained core faculty who are responsible for evaluation. About one third have formal grading meetings and use the RIME system; both have been associated with more robust and balanced grading practices. In particular, there is a wide variation between schools in the percentage of students who are awarded the highest grade, which has implications for residency applications. Downstream users of clinical clerkship grades must be fully aware of these variations in grading in order to appropriately judge medical student performance.
authors.affiliation: a Department of Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA.
authors.forename: Sara B
authors.initials: SB
authors.lastname: Fazio
authors.affiliation: b Department of Medicine , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA.
authors.forename: Dario M
authors.initials: DM
authors.lastname: Torre
authors.affiliation: c Department of Internal Medicine , Washington University School of Medicine , St. Louis , Missouri , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: DeFer
mesh_terms: D000328:Adult; D002170:Canada; D002982:Clinical Clerkship; D004504:Education, Medical, Undergraduate; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D008875:Middle Aged; D012577:Schools, Medical; D011795:Surveys and Questionnaires; D014481:United States
keywords: grading; internal medicine; medical students