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Monday, February 27 • 10:00am - 10:45am
ARCHES - [Oral Presentation] 1. Is there an “Honors” level of competency or is it time to retire the “H” grade in clerkships?

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10:00 AM - 10:15 AM

Is there an “Honors” level of competency or is it time to retire the “H” grade in clerkships? 

J. Colbert-Getz, M. Northrup, D. Roussel, A. Smith, University of Utah School of Medicine
Abstract Body: Purpose: With more and more medical school using the Entrustable Professional Activities (EPAs) as a framework for competency it is unclear if grading systems beyond pass/fail are necessary. However, a pass/fail clerkship grading system is in conflict with residency program selection, which place great emphasis on “honors” in a program specific clerkship (1). The main purpose of this study was to determine if faculty and residents who evaluate clerkship students conceptualize competency for “honors” as a norm-referenced standard or a criterion-referenced standard. It is important to understand how raters conceptualize honors because norm-referenced standards are not typical in a competency-based framework. The secondary purpose was to characterize the domains in which honors students stand out from non-honors students as perceived by faculty and resident raters. Approach/Methods In 2015-2016 the University of Utah School of Medicine required Critical Care Clerkship included a question on an EPA-aligned global rating form: Does this student perform at an honors level; if so, what distinguishes the student from a non-honors student? Two raters independently coded all qualitative responses (1) by any reference to criterion- or norm-referenced judgment for determining honors and (2) by EPA or non-EPA areas based on grounded theory for the later categorization. Any disagreement was discussed till consensus was reached between the raters. Results/Outcomes: There were 99 global rating forms completed on 81 students. Fifty-six of the forms indicated honors level performance and of those 20% described students’ performance in terms of norm-referenced judgments while the other 80% were based on criterion-referenced judgments. The top five topics mentioned for students with honors were work ethic (mentioned on 25% of 56 forms), patient-centered care (21%), teamwork or EPA 9 (21%), active learning (18%) and knowledge (16%). Discussion: When raters form a judgment about the honors student they are most likely to do so in a criterion-referenced manner. However, with the exception of teamwork, what distinguishes an honors student from a non-honors student is not necessarily captured in the EPAs. Significance Assessments aligned with EPAs may be useful for determining entrustment decisions, but may not accurately capture the honors clerkship student as conceptualized by faculty and resident raters. More large-scale research is needed before it can be determined if the honors grade is warranted in a competency based framework. References 1. National Resident Match Program. Results of the 2016 NRMP Program Director Survey. June 2016. Available online: http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf 

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Danielle Roussel

Assistant Dean for Clinical Curriculum, University of Utah

Monday February 27, 2017 10:00am - 10:45am

Attendees (13)