We thank Kates for his comments on our article. Although individual assessments are crucial for providing feedback to students and providing data to inform the clinical grade, clerkship grades include a combination of components, including assessments based on clinical performance, knowledge exams, clinical skills exams, and other work products, such as a written note. The author’s experience highlights the need for a shared mental model in how assessments are used to inform grades during the clerkship years and how expert judgment may be applied—whether that occurs through formal evaluation sessions1; clerkship grading committees2; or a system where a sufficient number of observations, raters, and types of assessment limits the bias introduced by one assessment.3
We appreciate Kates’ perspective and note that Bullock and colleagues’ article4 presents additional student perceptions on clerkship grading from 6 institutions. We have found Table 4 in this article particularly helpful in furthering conversations around trust building and assessment.
Finally, we see a common thread through all of these articles: the need for clear communication and transparency regarding clerkship grading and its components for all stakeholders in the process.
1. Hemmer PA, Dadekian GA, Terndrup C, et al. Regular formal evaluation sessions are effective as frame-of-reference training for faculty evaluators of clerkship medical students. J Gen Intern Med. 2015;30:1313–1318.
2. Frank AK, O’Sullivan P, Mills LM, Muller-Juge V, Hauer KE. Clerkship grading committees: The impact of group decision-making for clerkship grading. J Gen Intern Med. 2019;34:669–676.
3. van Andel CEE, Born MP, Themmen APN, Stegers-Jager KM. Broadly sampled assessment reduces ethnicity-related differences in clinical grades. Med Educ. 2019;53:264–275.
4. Bullock JL, Lai CJ, Lockspeiser T, et al. In pursuit of honors: A multi-institutional study of students’ perceptions of clerkship evaluation and grading. Acad Med. 2019;94(11 suppl):S48–S56.