Basics about Clerkships?

[deleted861279]

Can someone explain to me how clerkship grades work? How do the preceptor's rating of your performance and shelf exam grades get factored into an overall clerkship grade for one rotation?

Also, who are preceptors? Are they just regular doctors, or do they usually have some sort of special education background? Thanks!

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[MSTP18]

Literally the way clerkships grades are calculated can vary from clerkship to clerkship let alone school to school.

Preceptors are attending physicians that are faculty at the medical school. They may have anywhere from 0 educational training to graduate level educational training.

 

[NickNaylor]

1) Grading will very from clerkship to clerkship and among school to school. Most schools will determine your grade based on your performance on a shelf exam - which is basically a final exam that covers medical knowledge you theoretically should have learned over the course of your clerkship - and your clinical performance, which is much more subjective and focused on professional skills and competencies rather than medical knowledge. A school or particular clerkship may also include other components in your grade; my institution's psychiatry clerkship, for example, has students create a detailed case write-up which forms about 10% of the final clerkship grade. How exactly an individual clerkship or school utilizes these components is extremely variable.

2) As above, preceptors are typically physicians that are on the faculty of the institution that you will be rotating at. Their interest in, and ability for, teaching may be highly variable. For some faculty, teaching may be a necessary evil of their job and not something that they particularly value or are interested in. For others, teaching may be the primary reason that they are working at an academic institution in the first place. Some institutions may provide formal teaching to faculty about supervising medical students and being an effective clinician-educator, others may provide zero guidance. Generally, evaluations by trainees of the faculty member play some kind of role in the faculty's formal evaluation and assessment, but again, this can vary quite a bit.

Speaking broadly, the preceptor's responsibilities are to 1) supervise you to ensure that you're not doing anything dangerous, 2) teach you skills and medical knowledge relevant to the clinical service you are rotating on, and 3) provide you with feedback - both good and bad - so that you can continue to grow as a professional. The degree to which any one preceptor may do those things and vary widely.

 

[deleted861279]

Thank you everyone for the helpful responses! If anyone else wants to chime in, feel free to

Also, how long are clerkships typically?

Likewise, during fourth year, how long are away rotations usually? If you’re really interested in one residency program and want to establish connections, can you have the option of staying there longer? I’m thinking it probably varies based on the medical school

 

[MSTP18]

Thank you everyone for the helpful responses! If anyone else wants to chime in, feel free to

Also, how long are clerkships typically?

Likewise, during fourth year, how long are away rotations usually? If you’re really interested in one residency program and want to establish connections, can you have the option of staying there longer? I’m thinking it probably varies based on the medical school

4-8 weeks at my medical school

Aways are typically 4. More likely than extending an away is probably choosing to chain aways at an institution (e.g. medicine sub-I followed by a few weeks on a consult service)

 

[LizzyM]

Schools are becoming more sophisticated in providing training for faculty on how to teach and how to assess what students have learned.

Some schools have rubrics with "anchors" that describe observable and measurable benchmarks. For example 1= student is unable to generate a problem list 2 = student is able to generate a problem list but with serious omissions 3 = student is able to generate a complete problem list 4= student generates problem list and can generate a partial treatment plan 5 = student generates problem list and generates a complete treatment plan.

At the level of M3, a student may be expected to be a 3. A 4 or 5 would be expected of a resident or fellow.

The rubrics and the corresponding competencies that underlie them are created by medical education specialists (physicians and specialists in adult education) and provided to each clerkship preceptor.

 

[deleted923293]

This might sound like a silly question. But as a follow-up, how far away are the 'aways' usually? Is it something where you're commuting a couple hours away every day? Or if it's far enough away, do students arrange lodging for the duration of the rotation?

 

[LizzyM]

This might sound like a silly question. But as a follow-up, how far away are the 'aways' usually? Is it something where you're commuting a couple hours away every day? Or if it's far enough away, do students arrange lodging for the duration of the rotation?

Away rotations are elective and are places you think you’d like to match for residency. Short term housing can be arranged for the month; you sublet your place and you rent or sublet a place where you are rotating.


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[Lawpy]

Some schools have rubrics with "anchors" that describe observable and measurable benchmarks. For example 1= student is unable to generate a problem list 2 = student is able to generate a problem list but with serious omissions 3 = student is able to generate a complete problem list 4= student generates problem list and can generate a partial treatment plan 5 = student generates problem list and generates a complete treatment plan.

At the level of M3, a student may be expected to be a 3. A 4 or 5 would be expected of a resident or fellow.

Unfortunately, this system brings a lot of subjectivity and it's a major reason why many students rightly despise MS3 with a burning passion. If MS3s are starting off completely ignorant and are there to literally learn, the attendings/residents just blindly give them 3s (i.e. 3-bomb them) regardless of their performance and end up sinking their grades, which affects their residency goals. Not to mention, attendings/residents can be heavily biased, malignant, abusive, bigoted, etc. all the factors explaining why they shouldn't teach but teach anyways, further affecting the grades beyond students' control.

Subjectivity may be necessary but there are ways to approach it without being so rigid and apathetically destroying a student's career goals.

 

[LizzyM]

But 3 is a fair grade for a trainee who has not mastered, and is not expected to have mastered, certain skills. We need to re-think grading and accept that you won't be a 5.0 in all skills as a green M3 or even M4.

 

[ciestar]

But 3 is a fair grade for a trainee who has not mastered, and is not expected to have mastered, certain skills. We need to re-think grading and accept that you won't be a 5.0 in all skills as a green M3 or even M4.

Tell that to residency programs that expect those 5.0s/honors in clerkships.

 

[LizzyM]

Tell that to residency programs that expect those 5.0s/honors in clerkships.

And that's the real problem that leads to what is, in essence, grade inflation until grades are meaningless in distinguishing the average from the exceptional. And you aren't likely to find that everyone is exceptional but most are average (that is the very meaning of average).

 

[WedgeDawg]

Yeah the problem is not that MS3s aren’t getting evals saying “functioning at the level of a 2nd year resident” or 5/5 or whatever because I promise you no MS3 is doing that: the problem is that such a level of performance is what is expected for an honors. Schools that have figured out how to address this have fairer grading systems and better ways of differentiating students working at an honors level vs high pass level vs pass level vs remedial. Schools that haven’t done so make it more difficult for residents/attendings to give students accurate evals because there then exists a discrepancy between the grade and the evaluation.

My medical school had a very structured and objective way to evaluate students in different competency areas relative to their level of training. It was easy for me to get and receive formal feedback and evaluation. My current institution is much less nuanced and it’s difficult for me to objectively evaluate medical students in a way that isn’t both 1) honest and 2) potentially unfairly affect their grade.

So it’s more complicated than just having residents/attendings “3-bomb” students.

 

[The Knife & Gun Club]

Here’s a sample breakdown from my schools psychiatry clerkship:

Final Exam: 40%
Lecture Attendance: 5%
Case Write-up 5%
OSCE: 10%
Preceptor Evaluations: 40%

Preceptor evaluations is made up of a questionnaire where the student is ranked from 1(profound deficits) to 5 (senior resident level performance) across 5 dimensions of clinical competence. They then provide a narrative summary which goes in your deans letter. The preceptors are 2 attendings and 2 residents. The attendings generally assess things like knowledge base, presenting on rounds, teaching points, etc. the residents usually have a better handle on your professionalism and ability to work in a team.

overall I like our system. It varies from clerkship to clerkship, but the basic design is pretty constant. And at the end of the day the narrative comments carry far more weight than the grade assigned (we give numerical grades, not honors/pass/fail)

**an OSCE is a videotaped encounter with an actor/standardized p

 

[The Knife & Gun Club]

This might sound like a silly question. But as a follow-up, how far away are the 'aways' usually? Is it something where you're commuting a couple hours away every day? Or if it's far enough away, do students arrange lodging for the duration of the rotation?

You do aways at a hospital or in a region where you’d like to match. For example we have a local DO school and plenty of Their students do “aways” at our academic center. So they’re likely commuting the extra 20 minutes to get over here from their home campus. They usually pay only a nominal fee.

Im looking to leave my region, so both my aways were >1000 miles from home, where I had to rent a car, get short term housing, Etc. Those 2 months of aways cost me ~$5,000.

 

[jurassicpark]

Grading by preceptor as has been pointed out varies completely from institute to institute, and literally preceptor by preceptor. Yes, some are preceptors only because they're forced to to continue working at that facility. Or some think everyone is average unless they cure cancer. It varies tremendously. Preceptors are "regular" doctors.

I've never seen it as my duty to score people low. In fact, I take the opposite, I like to score people high. I've only "failed," one student in my life. And by failing, I mean trashing the heck out of his eval without an actual F (since F take a lot of administrative time) so he would never get a residency. Laziest medical student ever.

But otherwise, I take the view that medical students are a lot like puppies. If they're eager and excited, I don't care if they're full potty trained by the time they leave my service, I can gauge that they made progress and that's what I look for.