title: Defining Honors in the Surgery Clerkship.
abstract: Although highly influential, no published criteria exist that define who should receive the highest grade in the core surgery clerkship ("honors"). Therefore, significant variability exists in how this evaluation is assigned. Identifying the critical characteristics of the student receiving this grade can improve its usefulness in residency selection, class standing, and direct students' efforts. The purpose of this study was to attain expert consensus on the characteristics of an honors student in the core surgery clerkship.
  
  
  
  A 3-round modified Delphi technique was used in 2 parallel cycles to obtain expert consensus from the major stakeholders-program directors and clerkship directors in surgery. Experts were recruited from across the United States, although not from the same institutions. The 2 consensus lists were evaluated for congruency.
  
  
  
  All 15 of the invited clerkship directors and 14 of 15 invited program directors participated. A total of 65 unique characteristics were submitted by program directors and consensus was reached on 23. Clerkship directors submitted 62 characteristics and achieved agreement on 22. Ten of the final characteristics were identical between the 2 groups. These were communication skills, "shelf" exam score, synthetic ability (organizing data into meaningful care plans), absence of professionalism issues, outstanding work ethic, taking advantage of learning opportunities, accurate and complete history and physicals, enthusiasm, becoming an essential member of the care team, and outstanding clinical acumen.
  
  
  
  Expert consensus on the characteristics of an honors student in the core surgery clerkship was achieved. By using these criteria, the honors grade becomes emblematic of these 10 characteristics. This might reduce grade inflation within and between institutions, provide program directors with a consistent and reliable assessment of excellence, and effectively direct student efforts.
authors.affiliation: Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH. Electronic address: LipmanJ@CCF.org.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Lipman
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Schenarts
mesh_terms: D002982:Clinical Clerkship / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D003697:Delphi Technique; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D013502:General Surgery / Q000193:education* / Q000592:standards; D006801:Humans; D014481:United States