To the Editor:
As I am a clerkship director, I read with interest “Determining grades in the internal medicine clerkship: Results of a national survey of clerkship directors,” by Hernandez and colleagues. 1 In their conclusions, they advocated “further study and innovation to improve CPAs [clinical performance assessments] rather than diminishing their value and/or weighting.” Additionally, they advocated reaching a consensus as to “if there should be certain threshold scores required [on the NBME Medicine Subject Examination (MSE)] to achieve a certain [clerkship] grade…” 1 I would like to point out that requiring a threshold score on the NBME MSE to achieve a certain clerkship grade, such as honors, would put more emphasis on the NBME MSE and diminish the CPA. Exactly how much exam emphasis and CPA diminishment would depend on which threshold score was chosen for the exam and what the weights were for the other assessments used to determine the clerkship grade. 2
If the desire is not to diminish the value or weighting of the CPA, then the needed consensus is not to have an exam threshold score to achieve a certain clerkship grade.
1. Hernandez CA, Daroowalla F, LaRochelle JS, et al. Determining grades in the internal medicine clerkship: Results of a national survey of clerkship directors. Acad Med. 2021;96:249–255.
2. Schilling DC. Using the clerkship shelf exam score as a qualification for an overall clerkship grade of honors: A valid practice or unfair to students? Acad Med. 2019;94:328–332.