Clerkship Objectives & Grading Policy

Our purpose is to provide second-year medical students with the “core” of OBGYN knowledge, skills, and professional attitudes that are fundamental for all student physicians. 

Clerkship Course Objectives

Knowledge

The student will learn:

  • Health maintenance and preventive care for women, including age-related issues in cancer screening, screening for other common adult-onset illnesses, nutrition, sexual health, vaccination, and risk factor identification and modification.
  • Acute and chronic conditions that are common in women’s general and reproductive health, including their diagnosis and treatment.
  • Principles of physiology and pharmacology applicable to women from puberty through their reproductive life and menopause, especially pregnancy and age-related changes.
  • Prenatal, intrapartum, and post-partum care of normal pregnancy and common pregnancy-related complications as well as the care of women with acute or chronic illness throughout pregnancy.
  • Fetal and immediate neonatal assessment. 

Skills

The student will demonstrate competence in:
 

Communication:

  • Interact effectively and sensitively with patients, families, and health care teams in verbal and written presentations Acute and chronic conditions common in women’s general and reproductive health, including their diagnosis and treatment.
  • Recognize the important role of patient education in the prevention and treatment of disease.
  • Verbal Presentations: Organize a case presentation to accurately reflect the reason for the evaluation, the chronology of the history, the details of physical findings, the differential diagnosis, and the suggested initial evaluation. Include age-specific information and a precise description of physical findings. Justify the thought process that led to the diagnostic and therapeutic plan.
  • Written Documentation: Document the independent clinical thinking of the student. When using templates, or their own prior documentation, students should carefully adjust the note to reflect newly completed work and to ensure the note is a useful addition to the medical record.

History Taking:

  • From patients in more complex situations such as in the emergency and labor setting, collecting complete and accurate information and focusing appropriately.
  • Describe how to modify the interview depending on the clinical situation—inpatient, outpatient, acute and routine settings.
  • Physical Exams:
  • Take complete and focused depending on indication and condition.

Clinical Problem Solving:

  • Using data from history, physical, labs, and studies to define problems, develop a differential diagnosis, and identify associated risks.

Clinical Decision Making:

  • Incorporating patient data with patient needs and desires when formulating diagnostic and therapeutic plans.

Evidence-Based Medicine:

  • Ability to conduct an evidence-based search surrounding a specific clinical question and to appropriately evaluate the literature to answer such questions.

Self-Education:

  • Recognize knowledge deficits and learning needs through a reflective self-assessment process, plan or seek assistance in remediation of knowledge deficits, develop key critical thinking and problem-solving skills. Seek feedback.

Professionalism

The student will be expected to:
 
  • Demonstrate compassion, empathy, and respect toward patients, including respect for the patient’s modesty, privacy, and confidentiality.
  • Demonstrate communication skills with patients that convey respect, integrity, flexibility, sensitivity, and compassion. 
  • Demonstrate respect for patient attitudes, behaviors, and lifestyle, paying particular attention to cultural, ethnic, and socioeconomic influences.
  • Function as an effective member of the health care team, demonstrating collegiality and respect for all members of the health care team.
  • Demonstrate a positive attitude and regard for education by demonstrating intellectual curiosity, initiative, honesty, responsibility, dedication to being prepared, maturity in soliciting, accepting, and acting on feedback, flexibility when differences of opinion arise, and reliability.
  • Identify and explore personal strengths, weaknesses, and goals.

 

Clerkship Grading Policy

Final Grade Overview

Final grades in the obstetrics and gynecology clerkship starting are determined based on clinical performance evaluations (60%), timely completion of professional responsibilities (5%), the NBME subject examination (“shelf exam”, 20%), the clinical reasoning essay exam (15%). To pass the clerkship, students must receive a passing grade on every component of the grade. Students with above-average performance are eligible to earn a grade of High Pass, and those with superior performance are eligible to earn a grade of Honors.

Students whose professionalism prompts concerns will see that reflected in their grade for the clerkship. Major professionalism issues may result in a Fail for the clerkship regardless of clinical performance grade or final exam score.

Students who do not complete their professional responsibilities (e.g., faculty/site evaluations, RCEs, mid-clerkship feedback forms, clerkship evaluations) by the stated deadlines are ineligible for Honors regardless of their clinical evaluations and exam performance. As a member of the educational team, student physicians must complete their documentation in a timely manner and contribute to the overall improvement of the clerkship. The "Honors" grade credits the student for fulfilling this responsibility and helping with this process.

Final Grade Components  

  • The clinical grade (clinical performance) constitutes 60% of the final clerkship grade. It is determined by the average of the corrected scores on the question listed at the bottom of the Clinical Evaluation Form called "Overall Clinical Performance.” The corrected score is the score from each evaluation after adjusting for individual evaluators’ historical grading track record (overall deviation from the mean).
  • The clinical reasoning essay exam (expanded H&P) constitutes 15% of the final clerkship grade.  The essay is composed of 4 sections based on one clinical vignette. It is graded out of 100 points (25 points per section). A minimum score of 70 is required for passing.
  • The NBME subject examination constitutes 20% of the final clerkship grade. A minimum score of 60 is required for passing.

Grading Process

  • The grading committee meets within 4 weeks of the completion of the rotation to review the clinical scores, the exam scores, and all the comments on the student’s clinical performance.
  • Median scores and standard deviations are calculated for the following components: clinical evaluations, performance on the clinical reasoning essay examination, shelf examination, and professionalism.
  • Grades are impacted by how a student performed on the clinical evaluations and exams in comparison to the cohort and set eligibility/cutoffs for Honors, High Pass, Pass (Marginal Performance), and Fail.
  • A “Hawks and Doves” model is used, and final grades are not determined by the reported clinical score absolute numbers, rather mean scores and standard deviations for each evaluation based on the evaluator’s historical record are determined and these are averaged for each student and used in the calculations of the final grade. If there is a significant discrepancy between clinical performance scores between evaluators with an outlier, the committee will take that into consideration and adjust as necessary.

Final Grade Calculations

  1. Compute standard scores for all fractions of the grade Z = (student score - mean score per group)/ SD
  2. Compute the total weighted composite score.
  3. Composite Score= (zclinical*0.60+zshelf*0.2+zessay*0.15 +zPR*0.05)+3
  4. Students with Composite Score 3.7 or above are eligible to receive Honors. Those with a Composite Score at or above 3.2 but lower than 3.7 are eligible to receive High Pass. Students below 3.2 who receive a passing grade on all components of the grade will receive a final grade of Pass.

Honors, High Pass, and Pass Grading Criteria

The following is a synopsis of what makes a student eligible to receive grades of Honors, High Pass, Pass.

The Honors Student:

  • Functions like an intern, actively participating in all aspects of patient care (including workups, triage, operations, note writing, clinic activities) and does so at a level of competency clearly far beyond that expected of an M2.
  • Displays exemplary interpersonal skills with all members of the health care team, including physicians, nurses, clerical personnel, and paraprofessional colleagues.
  • Demonstrates a polished, poised, professional demeanor toward patients.
  • Performs required tasks efficiently and punctually with no need for continual reminders or prompting.
  • Is highly motivated; reads from a variety of sources; is well-prepared to discuss Ob/Gyn topics on rounds, in the OR, in the clinic, and on labor and delivery.

The High Pass Student:

  • Clearly is a motivated, enthusiastic, capable individual who is functioning well above the level expected of an M2, but not quite up to intern level.
  • Demonstrates a solid performance including, but not limited to, accurate, well-written histories and physicals, progress notes, operative notes, and the like.
  • Is a good team player, kind and polite to patients and staff, works cooperatively.
  • Dependable and punctual without need for prompting and reminding. Above-average surgical skills for level of training.

The Pass Student:

  • A capable individual who is functioning at the level expected of an M2.
  • Demonstrates a solid performance in obtaining a full history and performing an exam.
  • A good team player, kind and polite to patients and staff, works cooperatively.
  • Dependable and punctual, needing a minimum of prompting and reminding. Average surgical skills for the level of training.

The Pass Student (Marginal Performance):

  • Is the person who demonstrates a below-average performance. Deficiencies can be apparent in a variety of areas, including, but not limited to inappropriate interactions with staff and patients; inability to consistently meet the clinical responsibilities in the clinic, on-call, during operations, or in meetings; major inabilities to apply didactic knowledge to clinical situations; defiant or openly antagonistic attitudes to fellow students and staff.
  • The student who is headed in this direction will have a special session with the persons administering the program at their site to review concerns and discuss ways of improving performance. Only a demonstration of redeeming qualities will warrant a passing grade.

The Failing Student:

  • This is considered a failing grade that will require remediation in the form of repeating the entire clerkship.

Exam Failure Policy

If overall clinical performance is average or better and the student fails one or more exams, the student will receive an I/E grade which must be remediated. The details of the remediation will be dictated by the medical school’s academic review board but will usually result in re-taking the examination(s). If a student fails either the clinical reasoning essay exam or the NBME Shelf Exam, then a grade of no higher than Pass will be possible for the Ob/Gyn clerkship final grade regardless of subsequent performance on the repeat examination.

If a student does not receive a passing performance on his/her ward performance, the student will be assigned a grade of Fail and will have to repeat the rotation, or a portion of the rotation, as determined by the Medical School Academic Review Board.

Final Grade Availability

Final grades will be available online 4 weeks after the end of the clerkship. Students may view their final grade and comments on their final clerkship evaluation form but may not view an individual faculty or house officer evaluation form unless they have completed an individual evaluation of that faculty or house officer.

Grading Concerns and Questions

If you have concerns about an individual evaluation, we strongly encourage you to bring them to your Clerkship Director as soon as possible. Although the Clerkship Director can't change the evaluation, they can help you design a plan to work on the issues raised by your evaluators. We strongly discourage students from directly confronting their evaluators once the evaluations are final. Although two-way feedback is essential while you are working together, for a student to directly challenge an evaluator (or vice versa) after the final evaluation is complete is usually seen as unprofessional and rarely helps. Working with the Clerkship Director is generally much more productive.

If you have concerns about your overall grade for the clerkship, you can dispute your grade in writing according to the process and timeline below. Circumstances in which a dispute would be appropriate may include an apparent mathematical error in computing your final grade or a technical problem with the evaluation process. Grade disputes focusing on individual evaluations have never resulted in a change in the overall grade for the clerkship.

Grade Dispute Timeline

A request for a grade review must be made before 8 weeks following the end of the clerkship. This means that the student will have 4 weeks to appeal a grade. (For situations in which the grade was finalized longer than 4 weeks after the end of the clerkship, the student should never have less than 4 weeks to appeal a grade). This is a practical matter for the clerkship because an appeal for grade change that comes in after too much time has passed may not allow for an accurate reassessment due to faulty memories.

Grade Dispute Process

A student who believes he or she has been improperly graded must first read the Grade Grievance FAQ and then submit the Grade Dispute Form. The clerkship director will review the form and the student’s grade and respond in writing to the student’s concerns within 2 weeks.

If the student is not satisfied with the outcome, the student should set up a meeting to discuss the matter with the Clerkship Director within 2 weeks (no more than 12 weeks total from the end of clerkship). This discussion should include a review of the criteria established by the clerkship for the assignment of the grade, the actual performance of the student, and the reasons the student believes the grade is inaccurate.

If the issue is not resolved after the meeting and/or the student is not satisfied with the Clerkship Director’s explanation, the student, no later than 2 weeks after this meeting, may submit a written grade grievance as outlined in Section V- Grade Grievances of the Student Handbook, Policies for Medical Student Evaluation, Advancement, and Graduation.