Transition From Normative to Criterion-Based Grading in the Obstetrics and Gynecology Clerkship

Abstract

OBJECTIVES To compare grades, National Board of Medical Examiners (NBME) Shelf Exam scores, and student satisfaction with the Obstetrics and Gynecology (OB/GYN) clerkship after transitioning from normative to criterion-based grading. METHODS Between July 2021 and July 2022, the Icahn School of Medicine at Mount Sinai (ISMMS) adhered to a normative grading scheme in which ∼60% of students achieved a grade of Honors, 30% achieved a grade of High Pass and 10% achieved a grade of Pass for the OB/GYN clerkship. In July 2022, ISMMS transitioned to a criterion-based scheme. In this scheme, 6 competencies were created. Criteria were determined for each competency, delineating achieving a score of “Pass” versus “Honors” for the specific objective. Students needed to meet the criteria for Honors for 4 out of 6 of the competencies in order to ultimately receive a grade of Honors for the clerkship. The number of students achieving Honors, NBME shelf exam scores, and student clerkship satisfaction ratings between the normative and criterion-based schemes were compared. RESULTS The number of students studying in academic year (AY) 2021–2022 and AY 2022–2023 were 134 and 137, respectively. A significantly lower percentage of students received Honors in AY 2021–2022 than in AY 2022–2023 (66% vs. 96%, P < .01). Mean exam scores were significantly higher for those receiving Honors in AY 2021–2022 than in AY 2022–2023 ( P < .05); scores for AY 2021–2022 and AY 2022–2023 were 78.9, 95% CI [77.6, 80.1] and 76.7, 95% CI [75.6, 77.8], respectively. Mean exam scores for all students were not significantly different between the 2 academic cohorts (77.8 vs. 76.2, P = .06). Clerkship satisfaction rating was significantly higher in AY 2022–2023 than in AY 2021–2022 (4.1 vs. 3.7, P < .05). CONCLUSIONS These findings support a paradigm that compares learner performance to predefined measures as opposed to peer performance.