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