Grading (Assessment)

• Document competency

  1. • Department of Pediatrics along with the rest of the SOM has a responsibility to students, faculty, alumni, and society to graduate competent physicians.

     • Successful course completion means a student met course knowledge, skills, and professionalism objective

     • Competency criteria are based on pre-established criteria and NOT dependent on others’ performance.

     • Our goal is for ALL students to get there by the end of each course

• Identify students who need additional help ideally prior to course completion

  1. • Students are encouraged to be proactive in contacting course directors if concerned about meeting course objectives.

     • Supervising physicians along with peers and other team members are expected to contact the course director with concerns about student performance which might include medical knowledge, skills, and/or professionalism.

     • The course directors will work with the student and if needed involve others (director of pediatric student education, the dean’s office) in formulating an individual success plan

Identify students who excel ideally prior to course completion

• Students are encouraged to be proactive in formulating their own goals and objectives for each course and discussing them with supervising physicians. There intentionally is no upper limit on entrustment. Students should feel appropriately challenged and those performing at a high level are typically given more responsibility. We intentionally warn students (1) the goal posts might appear to be moving and (2) it’s a sign they are doing great. For instance a clerkship student who is excelling might be encrusted with more patients and higher level of responsibility more typical of a fourth year student.

• Final assessment of a student in every course includes a letter grade and a narrative summary

• The course director is responsible for the final grade assignment taking into account input from others. In some courses including hte clerkship that input is in the form of assigned individual OASIS evaluations. In other courses it is via more informal discussion.

• Timeliness

  • The Department of Pediatrics, SOM, and governing bodies including the LCME have strict guidelines regarding timely evaluation

  • Grades from individual supervising physicians are required to be submitted within 2w of course completion

  • Final course grades and narratives are required to be submitted within 4w of course completion

  • We make every effort to receive all assigned evaluations

• Pass/Fail. Pre-clerkship courses, third year career explorations, and few fourth year electives

• Pass/Near Honors/Honors: Third year clerkships and most fourth year electives

• Clerkships: 2 independent grades: NBME grade and a clinical performance grade

• Honors. Excelled. In third year clerkships the criteria are very specific. In all other courses criteria are at the discretion of the course director. Neither SLU SOM nor the Department of Pediatrics sets limits on the number of students who can achieve H or NH grades in our fourth year courses. Since students enrolling in the electives are a self-selected and typically highly motivated group, grades are typically more skewed towards NH and H.

• Near Honors. Exceeded expectations. In third year clerkships the criteria are very specific. In all other courses criteria are at the discretion of the course director.

• Pass. Met expectations

• In Progress. Was close to meeting course objectives though requires remediation in a specific area. Remediation plan is developed by the course director in collaboration with the dean for pre-clerkship or clinical education and approved by the student progress committee. Following successful remediation, grade changed to a Pass.

• Fail. Did not meet course objectives and/or failed to remediate. Requires repeating the course

• Incomplete. Did not attempt all course components. This is a “placeholder” grade. The most common scenario is a student who missed a critical part of the course due to an excused absence (Eg. clerkship student missing an OSCE exam due to illness) . Once course work has been completed, I is replaced by an appropriate grade.

• The narrative comments in individual evaluations should include specific things a student does well (and should continue doing) as well as specific suggestions for improvement. Occasionally individual evaluators mistakenly put comments in the wrong OASIS box (Eg. put constructive suggestions in the “things student does well”.) It is not a problem as the summaries are written manually as opposed to being auto-populated.

• The course director uses positive comments regarding student performance gathered from a variety of sources (Eg. direct observation by the course director, comment submitted by individual supervising physicians, comments submitted by patients and families, etc) to formulate a brief narrative summary which is later included in the MSPE/dean’s letter. No constructive or negative comments are EVER included. There is actually a lot of debate nationally regarding the value of MSPE letters and narratives… but that’s a much bigger issue.

• The assessment should never come as a surprise to the person being evaluated: student, resident, fellow, faculty, site director, course director.

• The Department of Pediatrics expectation is ongoing informal coaching among team members throughout all of our courses. We also expect a minimum of one formal sit-down session during the first part of each course to discuss performance to date as well as specific suggestions for improvement as well as a final in person discussion of final performance and grade at the end of each course.

• Evaluations assigned TO students (evaluation of supervising physicians, course, clinical site, course director) have long been de-identified and released by the SOM only once sufficient number of evaluation had been completed to preserve student anonymity.

• Evaluations OF students by supervising physicians

  • De-identified first in 2020-21 academic year and a decision the clinical and curriculum committee arrived at after a lot of discussion. The big driving force was severe grade inflation. Supervising physicians were incentivized to “upgrade” students since (1) no student ever complains about getting a too high of a grade (2) high evals make students happy and happy students are nicer when they fill out supervising physician evals. This is how we ended up with almost no variance in clinical performance grades.

  • Students able to view student performance evaluations in OASIS as soon as they are completed by the supervising physician but might not necessarily know which supervising physician or which setting the evaluation is from.

  • Supervising physician strongly encouraged to use the full spectrum of scores when assessing students

• We strongly encourage students to review clinical performance evaluations in real time.

• Steps we recommend for students who feel a grade and/or a narrative comment did not match performance

  • Self reflection

    • Take a step back. Give yourself at least two days, and then come back and reflect.

    • Assume positive intent. Reframe the comment as coaching rather than criticism. The vast, vast majority of supervising physicians really have students’ best interest and ongoing growth as a physician in training in mind. Writing a positive evaluation is very easy. Writing one with constructive suggestions is much harder and more time consuming.

    • Look for “nuggets of truth” and actionable steps. Supervising physicians base their evaluation on both their observations AND their interpretation of those observations… which don’t always match student’s intention. Even if the conclusion the evaluator drew was erroneous, what observable behaviors might have led him or her to this conclusion? Is there anything you could do to decrease the chances of the next supervising physician drawing the same conclusion?

    • Triangulate. How does the evaluation compare in-person feedback and other assessments you had received.

  • Discuss with course director

    • Students who continue to feel an assessment did not match their performance or who have questions about an assessment are encouraged to discuss their concerns with the course director within a week of receiving a given assessment

      • Learning opportunity. We strongly encourage students to review feedback in real time

      • Clerkship. As final H/NH/P assignment is dependent on performance of other students in the group, individual grade adjustments are made before assigning final grades

  • Formal grade appeal to student progress committee

    • The last option after discussion with the course director is a formal grade appeal process as outlined by the SLU SOM policies.