5.4: Evaluation of Performance in Clinical Clerkships

Due to the interruption of clerkships and clinical medicine by COVID-19, evaluations will still be obtained utilizing the same rubric but because of the unevenness of clinical experiences cross clerkships, all clerkships will be reported to the registrar as a pass or no pass.

Criterion-Based Evaluation System (CBES)

CBES refers to the evaluation system used in required clerkships at Stanford. Student performance is assessed in three domains:  Patient Care, Professionalism and Interpersonal Communication, and Medical Knowledge, as measured by a final written exam.  Students whose performance meets established criteria in each domain receive a mark of Pass with Distinction.  All students are eligible to earn Pass with Distinction, independently of how other students perform. Performance in each domain is reported separately in the Medical Student Performance Evaluation (MSPE), without reference to an overall grade.

Final Exam

  • Written exam requirements are set by the clerkship director.
  • Clerkships may use either the NBME Subject Exam or an alternative departmental exam. Clerkships using the NBME Subject Exam are marked with an asterisk above.
  • Written examinations must be passed with a minimum score as established by the clerkship.
  • Clerkship Exam thresholds for “pass” and “pass with distinction” are determined by each core clerkship and will be noted in each clerkship’s respective syllabus and/or orientation.
  • Students who do not pass the written exam receive an “N” (continuing) grade for the clerkship and must retake either the NBME Subject Exam or the departmental exam.
  • Students who do not pass the written exam on the second attempt must take an oral exam or a suitable alternative, to be determined by the clerkship director in conjunction with the Assistant Dean for Clerkship Education.
  • After the third attempt at satisfying the exam requirement, the “N” grade converts to either “pass” or “fail.”
  • “N” grades must be corrected within 9 months of the end of the clerkship. Uncorrected “N” grades will convert to “fail” after 9 months.

Electives/Selective Clerkship Grading

Students on elective and selective clerkships may earn a final grade of Pass, Marginal Pass, or Fail. 

Mid-rotation Feedback

All required clerkships must provide students a formal mid-clerkship assessment of performance. Mid-clerkship feedback must be provided early enough to allow a student the opportunity to improve their performance before the end of the clerkship. Clerkships must maintain written documentation that mid-rotation feedback has been provided to each student.

Clerkship Performance Evaluation Appeals

Students who have questions or concerns about a performance evaluation in a clinical clerkship should contact the Clerkship Director to request a review. If a student’s disagreement remains unresolved, the student or their Advising Dean may request a review by the Clerkship Evaluation Committee (CEC) by contacting the CEC chair. A written request for a review must be received within eight weeks of the date that the final student performance evaluation was submitted in MedHub in order to be considered.

The CEC consists of the following members (or their designees) who will participate in each appeal or review:

  • Director of Evaluation (CEC chair)
  • Assistant Dean of Clerkship Education
  • An Advising Dean other than the appealing student’s advisor
  • A Required Clerkship Director other than the director involved in the appeal
  • One additional faculty member (who does not hold a formal role in clerkships or CP3)

Upon receiving a request for review, the CEC will notify the clerkship team responsible for the performance evaluation and will gather data from the student and the clerkship team. The CEC will review the final evaluation and all submitted data, gather additional information as needed, and will generally, though it is not required, reach a decision by consensus. The student and clerkship team will be notified in writing of the final decision. The CEC will attempt to complete each appeal within 45 days of the request. The CEC decision is considered final. Students with further concerns may choose to pursue the Stanford University student academic grievance procedure, though they should recognize the limited scope of review inherent in that procedure.

Correction of Deficiencies in Clerkships

During the course of a clerkship, when a clerkship director becomes aware that a student’s performance may warrant a marginal pass or failing grade, the clerkship director must notify the student promptly that, in the absence of improvement, a non-passing grade is being considered. Once the director confirms the decision to assign a non-passing grade, the clerkship director must immediately notify the student about the final grade to be assigned. The clerkship director should also notify the student’s Advising Dean, who will arrange a meeting with the student.

Requirements for correcting a marginal pass or failure will be determined by the clerkship director. Students who receive a marginal pass or failing grade are required to meet with the clerkship director to set timely requirements for achieving an unqualified passing grade. Non-passing grades in clerkships, including N or “continuing” grades for failed NBME subject exams, must be corrected within one year of completing the clerkship. Students failing to correct a non-passing grade within one year will be reviewed and discussed by the Committee on Performance, Professionalism and Promotion.

Students cannot receive a Stanford MD degree with an uncorrected marginal pass or failure in a clerkship.

updated August 2020