In Reply to Schilling

We thank Dr. Schilling for his comments on our article. It was beyond the scope of our survey of internal medicine clerkship directors to give a recommendation for specific actions about how the NBME Medicine Subject Examination (MSE) is incorporated into the clerkship grade. We aimed to report current practices and clerkship directors’ perspectives in internal medicine to raise awareness of the range of ways the NBME MSE is being used at institutions across the United States in the internal medicine clerkship.

We hope the data presented in our article stimulate discussions and that agreement can be reached about an optimal way for all clerkships in internal medicine across the country to apply standardized multiple-choice question assessments, such as the NBME MSE. As Dr. Schilling points out and has stated elsewhere, ¹ there is a need for this approach across all clerkship disciplines as well. Even though the literature has supported moving away from a threshold NBME MSE score for certain clerkship grades, our survey found that the practice of using a threshold score continues. We hope that our article and this continuing discussion lead to a consensus on best practices.