Relationship between subjective grade and examination score in obstetrics and gynecology clerkships at community and university sites

OBJECTIVE: To determine if there were differences in a medical student's subjective grade and obstetric-gynecologic (OB/GYN) test scores based upon the student's site of rotation, hospital type or presence of OB/GYN residents.

STUDY DESIGN: We evaluated 521 students taking their third-year OB/GYN clerkship. The OB/GYN clerkship was eight weeks in length. The six sites (five community and one university) divided the OB/GYN rotations similarly. Five sites had OB/GYN residents; three had University of Illinois (UIC) residents. Comparisons were made between each student's subjective grade and OB/GYN final examination test score with respect to site, presence/absence of OB/GYN residents, community vs. university hospital and presence of UIC residents. Using the chi 2 test of association and regression models, we evaluated for relationships between the subjective grades, final examination scores and final grades. Significance was set at P < .05 for all evaluations.

RESULTS: Examination scores lowered final grades for 9.4% of students trained at the university hospital as opposed to 11.5% of nonuniversity hospitals. Final examination scores were lower than subjective assessments more often than in the nonuniversity hospitals (27.6% vs. 16.2%, P < .001). Hospitals with OB/GYN residents had less of a reduction in grades than did those without residents (8.9% vs. 24.6%, P < .0001) as well as lower final examination scores (with respect to subjective grade) (21.5% vs. 40.3%, P < .0001). The presence of UIC residents further reduced the incidence of examination scores lower than subjective assessment (19.7% vs. 34.0%, P < .0001). A linear correlation was noted between subjective grade and final examination score (r = .243, P < .001); this was strongest at the university hospital.

CONCLUSION: Students trained at a university hospital were less likely to have test scores lower than their subjective grades. Subjective assessments made in the presence of OB/GYN residents reduced the likelihood of a final grade reduction.