How Small Differences in Assessed Clinical Performance Amplify to Large Differences in Grades and Awards

A Cascade With Serious Consequences for Students Underrepresented in Medicine

Bibliographic Data

ID23354751
AuthorsArianne Teherani (0000-0003-2936-9832, is professor, Department of Medicine, education researcher, Center for Faculty Educators, and director of program evaluation, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID:., corresponding author), Karen E Hauer (0000-0002-8812-4045, is professor, Department of Medicine, and associate dean for assessment, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID:.), Alicia Fernandez (0000-0002-7975-6614, is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.), Talmadge E King (0000-0002-3526-2161, is professor, Department of Medicine, and dean, University of California, San Francisco, School of Medicine, San Francisco, California.), Catherine R Lucey (0000-0002-8345-2795, University of California, San Francisco), Catherine Lucey (is professor of medicine and vice dean for education, University of California, San Francisco, School of Medicine, San Francisco, California.)
Year2018
Volume93
Issue9
Pages1286-1292
Publication date2018-09-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAcademic Medicine (JOURNAL)
Journal identifiersISSN: 1040-2446 • E-ISSN: 1938-808X
PublisherOxford University Press (OUP) (PUBLISHER)
DOI10.1097/acm.0000000000002323
PMID29923892
OpenAlexW2808747795
LanguageEN
Citations received67
References cited37

While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013–2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students’ clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership—all of which influence residency selection and academic career choices. This analysis demonstrated differences that consistently favored not-UIM students. Whereas the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership. The authors use these findings to illustrate the amplification cascade, a phenomenon in which small differences in assessed performance lead to larger differences in grades and selection for awards. The amplification cascade raises concerns about opportunities for UIM students to compete successfully for competitive residency programs and potentially enter academic careers. Using a fishbone diagram, a continuous quality improvement root cause analysis tool, the authors contextualize their institutional results. They describe potential causes of group differences, drawing from the education disparities literature, and propose interventions and future research. They also share countermeasures adopted at their institution and encourage other medical schools to consider similar exploration of their institutional data.

Academic institution · Academic medicine · Class size · Diversity (politics) · Higher education · Honor · Management · Mathematics education · Medical education · Medical school · Political science · Psychological intervention · Quality (philosophy) · Sociology · Underrepresented Minority · Diversity and Career in Medicine · Innovations in Medical Education · Medical Education and Admissions · Medicine · Psychology

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