Trust Is Transparency: Clarify the Clerkship Grading Scale

To the Editor:

As medical students transition from their preclinical to clinical years, they finally experience a sense that they have joined the medical “team.” As with any team, trust in teammates is paramount. Where this trust often falters or even fails outright, as discussed in Dolan and colleagues’ Invited Commentary,¹ is in the evaluation process. Particularly with the transition of many medical schools to pass/fail preclinical curriculum, clerkship grades have become even more important in the establishment of an academic record for residency applications. As the authors discussed, even with the development of formal assessment tools, students still have great concern over evaluation.

A component of this uncertainty and ambiguity surrounding assessment, not addressed by the authors, is the disconnect between evaluators, students, and administrators over what these individual values actually mean. Although faculty often receive basic training in the use of assessment forms, many still have an apparent misunderstanding of how these evaluation scores are transformed into letter grades. This ambiguity is further compounded for residency directors attempting to evaluate medical student applicants given the wide variety of grading systems and reporting.²

During formative and summative feedback sessions with physicians and residents, I have had multiple revelatory discussions about how their numerical evaluation scores translate to letter grades. Many were shocked to hear that, though they believed the numerical scores they assigned were above average, they would convert only to a “B+,” not an “A” overall. One particular physician was rather distraught to find that her evaluations, especially of students she considered excellent, may have held them back from receiving an “A” in the clerkship. It is reasonable, therefore, that students might harbor a small sense of distrust in the evaluation system given that those responsible for evaluating students may not have a strong handle on the power their evaluations hold.

Generally, students want to trust their medical teams, teachers, and administration. A large part of developing this trust is transparency to all parties. Just as students seek transparency in how they will be evaluated, faculty, too, should pursue clarity and confirmation as to what their evaluations truly mean. I have no doubt that all parties seek student development and success, but these are best achieved with trust and teamwork.