"Making the grade:" Noncognitive predictors of medical students' clinical clerkship grades

Objectives: Because clinical clerkship grades are associated with resident selection and performance and are largely based on residents'/attendings' subjective ratings, it is important to identify variables associated with clinical clerkship grades. Methods: U.S. medical students who completed ≥1 of the following required clinical clerkships - internal medicine, surgery, obstetrics/gynecology, pediatrics, neurology and psychiatry - were invited to participate in an anonymous online survey, which inquired about demographics, degree program, perceived quality of clerkship experiences, assertiveness, reticence and clerkship grades. Results: A total of 2,395 medical students (55% women; 57% whites) from 105 schools responded. Multivariable logistic regression models identified factors independently associated with receiving lower clerkship grades (high pass/pass or B/ C) compared with the highest grade (honors or A). Students reporting higher quality of clerkship experiences were less likely to report lower grades in all clerkships. Older students more likely reported lower grades in internal medicine (P=0.02) and neurology (P<0.001). Underrepresented minorities more likely reported lower grades in all clerkships (P<0.001); Asians more likely reported lower grades in obstetrics/gynecology (P=0.007), pediatrics (P=0.01) and neurology (P=0.01). Men more likely reported lower grades in obstetrics/gynecology (P<0.001) and psychiatry (P=0.004). Students reporting greater reticence more likely reported lower grades in internal medicine (P=0.02), pediatrics (P=0.02) and psychiatry (P<0.05). Students reporting greater assertiveness less likely reported lower grades in all clerkships (P≤0.03) except IM. Conclusions: The independent associations between lower clerkship grades and nonwhite race, male gender, older age, lower quality of clerkship experiences, and being less assertive and more reticent are concerning and merit further investigation.