Thank you very much for your suggestions, aProgDirector. I have passed them on to our dean. In response to some of the points you made:
A couple of suggestions:
1. First, I'm not certain I understand why a medical school has to have no grades. I could imagine that the reason could be the following:
A. Grades create competition, and the school is trying to create a spirit of cooperation.
B. Grades don't really measure medical school performance well, and a portfolio is a better way of doing so.
C. The school believes that once someone's performance is "satisfactory", they do not want to report any more than that because that information can be misused. For example, there is no real reason that students going into dermatology have to be at the top of their class, other than medical schools report this and programs decide to use it.
Reason A is not true, IMHO. It might be true depending on how the school does it's grading, but many schools give those students who help others learn higher grades, and that alone would drive people to help each other.
Reason B is possible, but that assumes that a portfolio is a better way to assess performance, and that some way of reporting that in your application is possible.
Reason C is unrealistic. Programs have to decide whom they want based on something. If schools do not report any sense of how well a student has done, then we will use something else -- like USMLE's.
I would say that CCLCM doesn't gave grades for a combination of reasons A and B.
Concerning reason A: Like Ludiculo, I have never heard of a school grading students based on how well they facilitate other students' learning. Maybe you are referring to schools that grade their PBL sessions? If so, I don't agree that grading PBL does anything to encourage students to help one another. If anything, getting grades would probably make PBL stressful to the point that it would interfere with group function.
Concerning reason B: Our whole system is predicated on the idea that a portfolio evaluates the students' performance better than grades do. Even though a designation of H/HP/P is not given, the end-of-rotation evaluations compile the comments from all of the individual evaluations given by multiple attendings and residents, which gives a detailed picture of student performance.
IMO, relying on clinical grades only creates a different set of problems. Particularly for the clinical rotations, there is a significant degree of subjectivity in grading. Some attendings may refuse to give anyone honors, while others may give it to everyone. Also, the rotation director may not write any specific comments to justify the grade that was given. Thus, it might be difficult to interpret what a clinical grade means in terms of actual student performance.
2. If a school wants to make a portfolio evaluation system work, then I agree I'd need to see some of that portfolio. This is where things get tricky, and demonstrates the difference between a portfolio and a transcript. In a transcript, I get to see all of your grades. In an artist's portfolio, they get to show me only what they want -- a sampling of their best work. This allows students to bury any problems / concerns raised.
I should have clarified before that even if a student wanted to cherry-pick the best individual evaluations, it would not be possible to do that with the rotation evaluations. In addition, one of our competencies is reflective practice, which requires us to address weaknesses along with developing a plan to improve them. It would not be acceptable for a student to claim that there is no area where improvement is needed.
So, here's what I would want:
1. I don't need anything from the first two years. I'll use your step 1 score to measure that. Of course, if you would have done really well in a graded environment and then you botch you step 1, I would never know and assume the Step 1 is accurate. The opposite is also true, so this could work both for and against you.
True. This is a risk that students who attend any school with P/F grading during the first two years have to be willing to accept.
2. All of your third year evaluations, verbatim. No editing, no selective selection of statements. Yes, this means that there will be some negative / contructive criticism statements in there. That's life.
3. Same for a Sub I.
You and I are on the same page here. My thought was that the students should print and submit all of our end-of-rotation evaluations, or at least the evaluations that are relevant for that specialty. Again, it is not possible to print our evaluations with only the positive comments.
4. Honestly, some sense of how well you've done compared to your peers. I don't need a class rank. I do think it's reasonable to know whether you're in the top, middle, or bottom third (or top, middle two, or bottom quartile -- or any other reasonable system).
This is one of your suggestions that I passed on to our dean, since the deans would have to provide this information.
Honestly, I'm open to new ways of doing things and I think that a portfolio evaluation for medical school is completely reasonable. It's just that some summary of your portfolio needs to be in your MSPE, rather than the statement that "it's been reviewed, and is acceptable".
I agree with you here. My assumption was that our end-of-rotation evaluations and/or the promotions committee's evaluation would be quoted in our Dean's letter, and I was surprised to read in your post that they are not. I gave this suggestion to the dean as well.
Thank you again for taking the time to answer my questions.
