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Who should pass? rong>Setting Standards to Determine Core Clerkship Grades in Pediatrics.
Dudas RA, Barone MA. Academic Pediatrics, 2014-05-01; 14: 294-300.

Reviewed by Tricia McBurney

What was the study question?
Can practical standards for pediatric clerkship final grades be set using a Hofstee method?

How was the study done?
During the Johns Hopkins pediatric clerkship, students earn up to 100 points from different activities (60 points for clinical performance, 25 for NBME Subject Exam, 5 for Professionalism/Accountability, 5 for Patient Safety Exercise, 5 for Midterm multiple-choice exam). Eight faculty members familiar with the clerkship’s curriculum and assessment methods answered 4 questions: (1) lowest and (2) highest acceptable percentage of students who should fail, and (3) the lowest and (4) highest acceptable score that should allow a borderline student to pass [out of the possible 100 points]. A 10-item survey was administered to the eight faculty members to assess attitudes.

What were the results?
The results were graphed and cut-points were set based on the Hofstee method. When the 2012-13 JHUSM students were retrospectively held to the new standards, 5 out of 116 students (all 116 had previously passed) would have failed. Seven out of eight faculty members felt this method was easy. All eight faculty felt that there had been grade inflation in the past. Five out of eight were comfortable having some students fail their pediatric clerkship.

What are the implications of this study?
The clerkship grading system must be clear and defensible. This application of the Hofstee method gives a solid starting point for establishing pass-fail cutpoints. In the discussion, the authors relate that it is much more difficult to establish pass-honors cut-points. With the subjectivity inherent to clinical evaluations, clerkship directors will welcome any further evidence-based ideas on standardization.

Editor’s note: All clerkship directors struggle with the issue of grading. This paper represents an important contribution to what should be an ongoing academic dialogue about assessing student competence or lack thereof in the pediatric and other clinical clerkships. The authors mention that setting a cutpoint for passing versus not passing a clerkship is both slightly easier and much more important than setting a cutpoint for a passing versus honors grade (RR).


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