Is there any way to successfully lobby for a grading policy change?

[Quizlet04]

Before you call us all a bunch of whiny, entitled gits, hear me out:

Our school has P/F the first two years, H/HP/P/F our M3 year, and A/B/C/F our M4 year.

Two weeks before the beginning of our M3 year, a new clerkship grading scheme was rolled out. The subjective measures are Professionalism, Communication, and Medical Knowledge. The objective measure is the NBME shelf. Each one of those criteria is graded on the H/HP/P/F scale. No part is worth more than another and no percentages or averages are taken.

Currently, the grade is determined by the lowest of those four criteria. For example:

• A student who receives Honors in Professionalism, Communication, and Medical Knowledge, but who receives HP on the shelf gets an HP for the clerkship.
• A student who receives Honors for Professionalism, Medical Knowledge, and the shelf but who gets a Pass in Communication gets a pass for the clerkship.
• A student who receives two honors and two HP gets a HP.
• etc.

The administration stated they would reevaluate the grades in December. Then in January. Now it's looking like February. There have been letters, petitions, comments and emails from site and clerkship directors, and basically as much as we can do besides self-immolating on the steps of the school. I'm pretty sure the curriculum committee student member might do this to get the point across because she's crazy. Anyway...

Are we being unreasonable in wanting this policy changed? Is there anything we can do to fix it? Our first two years took averages of class performance. Now the thing you're worst at determines your whole grade.

(I was out in the workforce for 6 years and I'm surrounded by lots of non-med people who have real jobs. All of them have different strengths and weaknesses. In non-insane workplaces, their bonuses and promotions take this into account. You can still get promoted if you're better at some things than others. Leaving aside gross incompetence, violations of protocol, or outright failure, I know people who do well at some things, are less good at others, and still succeed.)

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[username456789]

That policy is idiotic and the "educators" who came up with it should feel very bad about themselves.

I can all but guarantee this is the brainchild of some loonie getting a Med. Ed. degree of some sort and needs to publish some dad's on experimental and unnecessary grading methods, at your expense.

After all, the motto in education tends to be "if it ain't broke, fix it."

 

[deleted480308]

What was the reaction from the student who sat down with the dean?

Generally, an adult logical appeal to priorities of the administration (match rates/kindness/accuracy) works better than petitions as those start to sound like a rebellion.

 

[ProfMD]

That grading system sounds awful. I can't think of anything else you can do beyond the letters, petitions, etc you are already doing.

 

[Mad Jack]

Sounds ridiculous, but hey, third year grading policies are so all over the place that I'm surprised anyone takes clinical grades seriously at all.

 

[ProfMD]

Sounds ridiculous, but hey, third year grading policies are so all over the place that I'm surprised anyone takes clinical grades seriously at all.

A lot of us don't for that very reason.

 

[Psai]

That sounds incredibly stupid. Whoever came up with that idea and the guy that approved it are incredibly stupid. How are residency program directors supposed to take your school seriously with something like that on your transcript?

Also changing the grading system right before 3rd year instead of giving people time to digest it and give feedback is ridiculous. Not sure why your students haven't revolted yet, it's something that makes a huge impact on your future.

 

[Goro]

My Gawd!!! Can some of you who have taken Psychiatry coursework enlighten me as to what mental aberration would up with a grading schema as deranged as this???

OP, you have my deepest sympathies.

Are students allowed onto your Curriculum Committee or similar? That's the level I'd expect feedback to be given and taken.

Before you call us all a bunch of whiny, entitled gits, hear me out:

Our school has P/F the first two years, H/HP/P/F our M3 year, and A/B/C/F our M4 year.

 

[Quizlet04]

That sounds incredibly stupid. Whoever came up with that idea and the guy that approved it are incredibly stupid. How are residency program directors supposed to take your school seriously with something like that on your transcript?

We have no idea. Apparently our previous grading system was too lenient. Now it is too harsh. The criteria were changed enough that some site directors have said only residents will get honors. Hooray...

Also changing the grading system right before 3rd year instead of giving people time to digest it and give feedback is ridiculous. Not sure why your students haven't revolted yet, it's something that makes a huge impact on your future.

We are revolting (har). In no particular order, we have tried:

- Meetings between our student senator and the Dean of Students
- Meetings between our student government leaders and the deans who made this policy
- Letters to our clerkship directors
- Sitting on committees in charge of grading. There are two committees and at least one student is active in each.
- Private meetings with other members of our administration who may have the ear of the deans
- Question and answer sessions that ended in the dean pointing out a student committee member and telling the whole class to talk to that student (??????)

We're at the petition and survey section of our anger. We have gone through all the other channels.

 

[Quizlet04]

Are students allowed onto your Curriculum Committee or similar? That's the level I'd expect feedback to be given and taken.

Yes. They have been lobbying for changes since August with no success. Apparently students were involved in the initial creation of this system but maybe those students were insane. None of us heard about the changes until orientation.

I have been telling the administration, since I sit on a committee and I know many of the deans + admins personally, from day one this is a terrible idea. All the students are angry and no one has any confidence in the administration not to screw us over. People have talked about withholding tuition but we don't think we can.

 

[Psai]

Don't withhold tuition lol. What you need to do is make it public. Let all the applicants know that your school has done this and how unhappy your students are. The administration will notice the quality of accepted students dropping precipitously and will care about that.

 

[MrChance2]

I don't think its that bad. To me it seems like it will generate a lot of HP for their students and even the ones that P the rotation because of mediocre medical knowledge get to show a HP in communication and professionalism. Pretty much anyone without a personality problem should get HP for professionalism and communication on all clerkships. If the med school wants to deal with putting all this garbage into their deans letters then that's their problem.

The last interview I was at the interviewer went over my app pretty thoroughly and asked me about my hobbies, said I had good LORs, etc. He then skipped the like 7 pages of ridiculous 1-3rd year grades with graphs and convoluted scoring and metrics saying "I don't know why they send us this garbage, you think I'm going to try to interpret this"

 

[Quizlet04]

I don't think its that bad. To me it seems like it will generate a lot of HP for their students and even the ones that P the rotation because of mediocre medical knowledge get to show a HP in communication and professionalism. Pretty much anyone without a personality problem should get HP for professionalism and communication on all clerkships. If the med school wants to deal with putting all this garbage into their deans letters then that's their problem.

The last interview I was at the interviewer went over my app pretty thoroughly and asked me about my hobbies, said I had good LORs, etc. He then skipped the like 7 pages of ridiculous 1-3rd year grades with graphs and convoluted scoring and metrics saying "I don't know why they send us this garbage, you think I'm going to try to interpret this"

You assume there will be a breakdown. There won't. As far as I know, you will have a single grade reported for each clerkship.

 

[Manual Disimpaction]

And I thought our H/A/A-/B+/B/B-/C+/C/C-/F system was stupid... well it is, but not as stupid as what your school cooked up.

 

[Cognovi]

Nobody in this thread has justified how the grading policy is stupid.

Reasons a grading policy could be stupid include
1-poor discrimination
2-poor validity
3-poor reliability

A policy where everyone gets honors fails at 1. This might be the status quo. This new policy seems like a reasonable attempt to solve that without affecting 2 and 3. We can't have a productive conversation if we don't know what the real distribution of grades are. It could be that everyone gets honors in communication and professionalism so that's moot.

Actual distribution aside, the philosophical controversy boils down to over whether an average or lowest-value assessment makes most sense. How do you decide? You can say you would deem someone like House with great knowledge but poor professionalism to average out to be a 'good' doctor. Or you can say mediocre professionalism and communication are deal-breakers, so the lowest-value style makes sense.

 

[FiveOClock]

No.

 

[MrChance2]

You assume there will be a breakdown. There won't. As far as I know, you will have a single grade reported for each clerkship.

I didn't. Had an overall grade then like 5 sub categories.

 

[Psai]

Nobody in this thread has justified how the grading policy is stupid.

Reasons a grading policy could be stupid include
1-poor discrimination
2-poor validity
3-poor reliability

A policy where everyone gets honors fails at 1. This might be the status quo. This new policy seems like a reasonable attempt to solve that without affecting 2 and 3. We can't have a productive conversation if we don't know what the real distribution of grades are. It could be that everyone gets honors in communication and professionalism so that's moot.

Actual distribution aside, the philosophical controversy boils down to over whether an average or lowest-value assessment makes most sense. How do you decide? You can say you would deem someone like House with great knowledge but poor professionalism to average out to be a 'good' doctor. Or you can say mediocre professionalism and communication are deal-breakers, so the lowest-value style makes sense.

If someone is making a radical change to an established system, they should demonstrate some benefit to that change. Professionalism and communication are very nebulous. How do you grade communication? Medical knowledge is less vague but can be difficult to assess, especially if someone has a more quiet and introverted personality.

If everyone is getting honors that just means that they need to change the weighting given to shelf exams or something to allow for some discrimination. Adding more categories only serves to increase confusion, especially when no other school in the country is using this system. Third year grades are already difficult to interpret without adding 2 more categories of dubious quality.

 

[Cognovi]

If someone is making a radical change to an established system, they should demonstrate some benefit to that change. Professionalism and communication are very nebulous. How do you grade communication? Medical knowledge is less vague but can be difficult to assess, especially if someone has a more quiet and introverted personality.

If everyone is getting honors that just means that they need to change the weighting given to shelf exams or something to allow for some discrimination. Adding more categories only serves to increase confusion, especially when no other school in the country is using this system. Third year grades are already difficult to interpret without adding 2 more categories of dubious quality.

Clinical grading is subjective; that's unavoidable. There are ways to make it better defined and more reliable. Communication, professionalism, and knowledge can all be defined more specifically. I presume OP's school uses more specific criteria.

Many schools in the country use a H/HP/P/F system. That single grade is what people look for. This is just another way to arrive at that single grade. Many schools use a competency-based scoring rubric that includes professionalism and communication for each clerkship grade. As mentioned above, the transcript or MSPE doesn't go into the breakdown.

If you over-weight the shelf to create more discrimination, you're telling students communication and professionalism are valued less than your shelf performance.

 

[ortnakas]

This system sounds horrible and I'll quit complaining about my school's letter grading system now.

 

[Cognovi]

This grading policy is just an extension of the idea of a competency based system. If you fail a required course, you can't graduate. Here, if you perform at less than honors level in one of three key domains, you can't get honors. There are plenty of ways to deflate grades. This way is more palatable than norm-based grading, eg, only the top 25% of the class may earn honors. At least this way, it is possible for grades to be inflated anyway. As I said above, maybe everyone gets honors for communication and professionalism.

 

[aim-agm]

There's a lot you can do, depending upon who is on your side. Who is (i.e. student body, faculty, academic officers, administrators, preceptors, clinical site administrators, etc.)?

 

[Quizlet04]

This grading policy is just an extension of the idea of a competency based system. If you fail a required course, you can't graduate. Here, if you perform at less than honors level in one of three key domains, you can't get honors. There are plenty of ways to deflate grades. This way is more palatable than norm-based grading, eg, only the top 25% of the class may earn honors. At least this way, it is possible for grades to be inflated anyway. As I said above, maybe everyone gets honors for communication and professionalism.

Not everyone gets honors in communication and professionalism. Also, if every other part of the curriculum takes averages, why should this part not take the average? I don't mean failing vs. not-failing. I mean if you have two HP and two H, why is it HP and not H?

 

[Goro]

The OP's grading schema is a mish-mash of three different criteria. At least the P/F format is laudable because it is a stress reducer and a gunner repellant.

The H/HP/P/F and the A/B/C/F formats are the same thing. I can understand having some extended grading criteria beyond P/F for the clinical years as it gives PDs something to assess different residency candidates. But the H/HP etc system is merely a corruption of P/F. This started out from someone saying "we should have a way to give a distinction for our best students" which then mutated into "let's do that AND honor then next best students". Which leaves you exactly back with letter grades!

I submit that having a percentile system is better at least because students will then not have to fuss about a 79 needing to be an 80 for a B, or an 89 needing to be a 90 for an A.

Nobody in this thread has justified how the grading policy is stupid.

Reasons a grading policy could be stupid include
1-poor discrimination
2-poor validity
3-poor reliability

A policy where everyone gets honors fails at 1. This might be the status quo. This new policy seems like a reasonable attempt to solve that without affecting 2 and 3. We can't have a productive conversation if we don't know what the real distribution of grades are. It could be that everyone gets honors in communication and professionalism so that's moot.

Actual distribution aside, the philosophical controversy boils down to over whether an average or lowest-value assessment makes most sense. How do you decide? You can say you would deem someone like House with great knowledge but poor professionalism to average out to be a 'good' doctor. Or you can say mediocre professionalism and communication are deal-breakers, so the lowest-value style makes sense.

 

[Cognovi]

if every other part of the curriculum takes averages, why should this part not take the average

Because grades are inflated, because these domains of professionalism and communication are orthogonal ideas and more important in the clinical setting than the preclinical setting, and because there's nothing that is inherently more sensical or fair about an average than the lowest of a small set.

I submit that having a percentile system is better at least because students will then not have to fuss about a 79 needing to be an 80 for a B, or an 89 needing to be a 90 for an A.

The reason no schools have a percentile system is that students will then ALSO fuss about having a 88 instead of 89. It doesn't get rid of the neuroticism.

 

[Goro]

When my school switched from letter grades to percentile scores, it put an end to the grade grubbing. Since that time (and along time ago!) only one student has ever bothered me about how her 78 should really be a 79. She would actually bring me calculations to prove this that were so off the wall, I swear they warped space-time and one could have exceeded the speed of light.

She's now a Psychiatrist. Go figure.

The reason no schools have a percentile system is that students will then ALSO fuss about having a 88 instead of 89. It doesn't get rid of the neuroticism.

 

[aim-agm]

I submit that having a percentile system is better at least because students will then not have to fuss about a 79 needing to be an 80 for a B, or an 89 needing to be a 90 for an A.

I'm opposed to percentile/ranking systems since (a) they are variant based on performance of the classmates (i.e. same student in a different year or place with the same performance will get different results) and (b) it means that student success comes at the cost of other students' failure (i.e. you can't do better without someone else doing worse).

 

[Goro]

I'm having trouble following your logic. In any class, someone will always be doing better or worse than you, even in P/F.

Schools have test questions that are vetted historically...ie, we use item analysis to see how good a question performs on an exam. So, it's not as random from year to year as you imagine it is.

Students still get ranked even with P/F or letter grade systems. Like it or not, you kids are compared to each other and compete against each other.

I'm opposed to percentile/ranking systems since (a) they are variant based on performance of the classmates (i.e. same student in a different year or place with the same performance will get different results) and (b) it means that student success comes at the cost of other students' failure (i.e. you can't do better without someone else doing worse).[/QUOTE]

 

[Quizlet04]

I'm having trouble following your logic. In any class, someone will always be doing better or worse than you, even in P/F.

Yes. In a non-percentile class, the person doing better than me isn't keeping me from doing better. I get the grade I get regardless of what other people get. In a percentile system, the better people do, the worse I do.

Also my school randomly upped the percentile cutoff for HP on the shelf. It was for...reasons?

 

[Psai]

You're going to be compared no matter what the grading system is. Better get used to it.

 

[Goro]

OK, thin I understand where you're coming from. You seem to believe that medical school classes are grades in the same way as undergraduate Psychology classes. That's not the case. In my own course at my school (and the others I've been at), if you know 85% of the material, you get an 85%. If someone knows more than you, his/her grade is higher. If they know less, thier grade is lower. If they know the same as you, their grade is the same as yours. Your grade doesn't diminish just because people do better.

As for your HP grade cutoff changing...you'll have to ask your Curriculum Deans.

Yes. In a non-percentile class, the person doing better than me isn't keeping me from doing better. I get the grade I get regardless of what other people get. In a percentile system, the better people do, the worse I do.

Also my school randomly upped the percentile cutoff for HP on the shelf. It was for...reasons?

 

[Anicetus]

Some of our clerkships in 3rd year have "automatic fails" for a list of things. I know one of them is if you get below a standard deviation on the osce specifically, you fail the clerkship. Another is some combination of not getting a certain score on an observed H&P, you fail the clerkship, as well as 1.0 Standard deviation below the mean in like 2 categories, you fail the clerkship.

Yeah... Totally not stressful at all knowing when you walk into an osce you may very well be experiencing the most important 15 Minutes of your life right there.