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Mitigating Inequity in OBGYN Clerkship Honors Grading Using a Compensatory Grading Schema

Purpose: To evaluate the impact of grading changes in an OBGYN clerkship on honor grade distributions by race/ethnicity.


Background: Bias pervades medical student assessment, leading to grading inequities for students underrepresented in medicine (URiM). We describe the effects of changing our clerkship grading schema, from conjunctive to compensatory, on honors grade distribution by race/ethnicity.


Methods: In response to internal analysis identifying racial inequities in our Honors/Pass/Fail grading system, UC Davis School of Medicine changed the OBGYN clerkship grading schema from conjunctive, in which to receive honors students must meet thresholds for each component (NBME shelf, OSCE, clinical evaluations), to compensatory, in which each component contributes a percentage towards the grade. We evaluated the honors distribution compared to student representation with this change.


Results: With conjunctive grading, non-URiM students received disproportionate honors, with 42% of honors awarded to white students, who had 25% class representation, and 3% to Latinx students who represented 17% of the class. With compensatory grading, the total honors percentage increased from 30% to 38%. The proportion of honors awarded to Latinx and Black students improved (3% with 17% representation to 8% with 16% class representation; 0% with 2% representation to 6% with 13% representation, respectively).


Discussions: The grading inequity findings at our institution are consistent with those seen at other medical schools. The increase in total honors and improvement in distribution reflects the considerable  weight that a shelf score threshold can have on grading, but we have not yet achieved equity with this change to compensatory grading.

Topics: CREOG & APGO Annual Meeting, 2023, Student, Faculty, Clerkship Director, Clerkship Coordinator, Residency Director, Systems-Based Practice & Improvement, Practice-Based Learning & Improvement, UME, Assessment,

General Information

Student,Faculty,Clerkship Director,Clerkship Coordinator,Residency Director,
Systems-Based Practice & Improvement,Practice-Based Learning & Improvement,
Clinical Focus

Author Information

Caitlin Esparza, n/a; UC Davis School of Medicine; Marjorie Westervelt, PhD, MPH; Melody Hou, MD, MPH;

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