Oral examinations are not consistently included in third-year medical student clerkships. When included, they are often unstructured, leaving room for variations in difficulty or scoring. Previous research has demonstrated differences in clinical grade achievement, with underrepresented in medicine students receiving significantly lower grades than White students.
We designed a structured oral examination for third-year medical students on the surgery clerkship. Students completed 2 oral examination scenarios and were evaluated on their ability to complete a history and diagnostic workup, interpret laboratory and imaging results, and devise a treatment plan. Scores from our examination were compared to previous, unstructured oral examination scores and to student demographics. Students and faculty were surveyed regarding their experience.
Third-year medical students demonstrated strong knowledge of multiple surgical diseases. The greatest number of errors occurred in treatment planning (P < .001). Third-year medical students receiving honors clerkship grades achieved higher percentages of correct items on their oral examination. (94.8% vs 90.4%) (P = .02). Evaluation of prior unstructured oral examinations found underrepresented in medicine students received lower scores than White students (P = .04). After implementation of our structured examination, no difference was seen between the scores of underrepresented in medicine and White students (P = .99).
We implemented a standardized oral examination for third-year medical students on the surgery clerkship with student and faculty satisfaction and demonstrated the ability to determine domains of knowledge weakness. The application of our structured oral examination helped to address nonspecific grading practices and eliminate oral examination grade differences between underrepresented in medicine and White students.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- National landscape of general surgery mock oral examination practices: survey of residency program directors.J Surg Educ. 2018; 75: e54-e60
- Sequential participation in a multi-institutional mock oral examination is associated with improved American board of surgery certifying examination first-time pass rate.J Surg Educ. 2016; 73: e95-e103
- Oral examinations: actual and perceived contributions to surgery clerkship performance.Surgery. 1985; 97: 737-744
- Selection of medical students for graduate training: pass/fail versus grades.N Engl J Med. 1978; 299: 25-27
- Assessment, feedback and the alchemy of learning.Med Educ. 2019; 53: 76-85
- “Making the grade”: noncognitive predictors of medical students’ clinical clerkship grades.J Natl Med Assoc. 2007; 99: 1138-1150
- Can success in the surgical residency be predicted from preresidency evaluation?.Ann Surg. 1985; 202: 694-695
- The relationship between criteria used to select residents and performance during residency.Am J Surg. 1997; 173: 326-329
- Application factors may not be predictors of success among general surgery residents as measured by ACGME milestones.J Surg Res. 2020; 253: 34-40
- Association of demographic and program factors with American board of surgery qualifying and certifying examinations pass rates.JAMA Surg. 2020; 155: 22-30
- ACS/ASE Medical Student Core Curriculum.https://www.facs.org/Education/Program/Core-CurriculumDate accessed: March 16, 2021
- Underrepresented in medicine definition.https://www.aamc.org/what-we-do/equity-diversity-inclusion/underrepresented-in-medicineDate accessed: August 29, 2021
- Oral examinations in undergraduate medical education - what is the ‘value added’ to evaluation?.Am J Surg. 2020; 220: 328-333
- Swipe right for surgical residency: exploring the unconscious bias in resident selection.Surgery. 2020; 168: 724-729
- Underrepresented minorities in general surgery residency: analysis of interviewed applicants, residents, and core teaching faculty.J Am Coll Surg. 2020; 231: 54-58
- Objective measures needed - program directors' perspectives on a pass/fail USMLE step 1.N Engl J Med. 2020; 382: 2389-2392
- Curriculum Development for Medical Education: A Six-Step Approach.2nd ed. Johns Hopkins University Press, Baltimore, MD2009
- The usage of mock oral examinations for program improvement.J Surg Educ. 2017; 74: 946-951
- Evaluating Training Programs: The Four Levels.Berrett-Koehler Publishers, Oakland, CA2006
- Examining demographics, prior academic performance, and United States medical licensing examination scores.Acad Med. 2019; 94: 364-370
- Racial disparities in medical student membership in the Alpha Omega Alpha Honor Society.JAMA Intern Med. 2017; 177: 659-665
- 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.Acad Med. 2018; 93: 1286-1292
- Washington University School of Medicine in St. Louis case study: a process for understanding and addressing bias in clerkship grading.Acad Med. 2020; 95: S131-S135
Published online: December 08, 2021
Accepted: November 5, 2021
© 2021 Elsevier Inc. All rights reserved.