Beyond the Clerkship Grade: An Evidenced-Based, Pro-Equity Approach to Assessment for Both Tiered and Pass/Fail Grading Systems

Medicine clerkship directors face the challenge of assessing competency, assigning grades, and communicating a student's performance to residency programs while promoting equity for all clerkship students. Since the COVID-19 pandemic, this task has become increasingly complex, given alterations in the clinical learning environment, rapid changes in grading systems, the USMLE Step 1 exam change to pass-fail, and the focus on the UME-GME transition. Further, recent publications show that commonly used assessments, such as the NBME shelf exam and clinical evaluations of students, may perpetuate bias and inequality, particularly when used as summative assessment tools. Based on the needs of participants in previous workshop, presenters will focus on the best practices of clerkship assessment to both improve the quality of summative evaluation and ensure equity. Presenters will critically appraise the most recent literature for commonly utilized learner assessments such as the NBME shelf exam, clinical evaluations, workplace-based assessments (e.g., mini-CEX, direct observation, EPA assessment), OSCE, and note rubrics (e.g., IDEA rubric) and will demonstrate how clerkship directors can incorporate assessment data into the structured evaluative letter and use this data to develop individualized learning plans. Using the examples provided, participants will examine their current clerkship assessment methods to identify opportunities for improvement. Participants will leave with a comprehensive assessment toolbox and theoretical constructs to aid in the meaningful and equitable assessment of medicine clerkship students