A Rollercoaster of Grades Versus Growth in the Clerkship Year: A Phenomenological Study of Medical Student Experience with Competency Development.
Matthew Kelleher, Benjamin Kinnear, Danielle Weber, Abigail Martini, Sally A Santen, Pamela Baker, Laurah Turner, Eric Warm, Melissa Klein, Daniel Schumacher
Author Information
Matthew Kelleher: University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, US. ORCID
Benjamin Kinnear: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Danielle Weber: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Abigail Martini: Cincinnati Childrens Hospital Medical Center, Ohio, US.
Sally A Santen: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Pamela Baker: University of Cincinnati College of Medicine, Cincinnati, Ohio, US.
Laurah Turner: Department of Medical Education, University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Eric Warm: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Melissa Klein: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Daniel Schumacher: University of Cincinnati College of Medicine, Cincinnati, Ohio, US. ORCID
Purpose: As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated. Methods: In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice. Results: Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback. Conclusions: Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME.
References
Perspect Med Educ. 2016 Oct;5(5):276-84
[PMID: 27650373]
