How do you fairly assess a medical student with discrepant clinical evaluations? Or a medical student with professionalism concerns despite successfully completing all academic and clinical requirements? These are some of the challenges faced by Clerkship Directors when grading students.

Clinical competency committees (CCC) provide a methodical approach to assessing a medical student’s progress and readiness for the next stage of training. Unlike traditional grading policies that might promote a student who meets minimum criteria within a defined block of time, clinical competency committees evaluate a learner’s mastery of expected milestones (1).

CCCs have consistently been used in graduate medical education to communicate expectations, standardize evaluation of trainees, identify trainees who are not on a satisfactory trajectory, and develop individualized growth plans (1). Additionally, the CCC encourages a resident to assess their current ability in various competencies, reflect on any gaps, and take accountability for future growth (1). CCCs are a requirement for accreditation of residency and fellowship programs, and the Accreditation Council for Graduate Medical Education (ACGME), has published a comprehensive guidebook for programs to use (2).

Similar models have been used in undergraduate education (3-5). A national survey administered to internal medicine clerkship directors and conducted by the Alliance of Academic Internal Medicine revealed that 42% of respondents had some form of a grading committee. The grading committees varied considerably in content and purpose; however, they were primarily used to determine the final grade of students at risk for failing, have differing clinical evaluations, and have professionalism issues (6).

The AAMC Core Entrustable Professional Activities (EPAs) provides a standardized framework to evaluate a medical student’s readiness to enter residency, regardless of specialty. The authors define an “entrusted learner” as one who demonstrates proficiency across 13 defined behaviors without any direct supervision. Although there are similarities, the authors distinguish EPAs from competencies in that EPAs are intended to mirror real-life situations encountered by a physician during their daily workflow. Various competencies and associated milestones are integrated into each activity (7).

Although CCCs have the advantage of offering a standardized and transparent evaluation process based on expected competencies, there may be several barriers to successful implementation. Clerkships must determine the optimal number of committee members, types of committee members, and frequency of meetings. In addition, committee members must agree on the role of the CCC in determining grades and promoting student self-reflection and growth. Members must develop a shared mental model regarding the impact of variable grading styles used by evaluators when completing clinical evaluations, methods to address discordant data, and strategies to minimize bias (7). Despite these challenges, CCCs offer a promising method for ensuring medical students are on a successful trajectory for advancing to the next level.

What do you think?

• Are CCCs the optimal way to evaluate students? What are some of the limitations of this strategy?
• Does your UME program use a CCC? If so, what were some unexpected hurdles to overcome? Can you recommend some keys to success?
• Can you think of any examples where a CCC may have provided a different outcome in a student’s evaluation?

References

1. Goldhamer MEJ, et al. Reimagining the Clinical Competency Committee to Enhance Education and Prepare for Competency – Based Time-Variable Advancement. J Gen Intern Med 2022; 37 (9):2280-90.
2. Andolsek K, et al. Accreditation Council for Graduate Medical Education Clinical Competency Committees: A Guidebook for Programs (3rd ed). https://www.acgme.org/globalassets/acgmeclinicalcompetencycommitteeguidebook.pdf
3. Monrad SU, et al. Competency Committees in Undergraduate Medical Education: Approaching Tensions Using a Polarity Management Framework. Acad Med 2019;94(12:1865-72. doi:10.1097/ACM.0000000000002816
4. Murray KE, et al. Crossing the Gap: Using Competency-Based Assessment to Determine Whether Learns are Ready for the Undergraduate – to – Graduate Transition. Acad Med: 2019; 94(3): 338-45 doi:10.1097/ACM.0000000000002535.
5. Mejicano GC, et al. Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum. Acad Med 2018;93:S42-S48 doi:10.1097/ACM.0000000000002068.
6. Alexandraki I, et al. Structures and Processes of Grading Committees in Internal Medicine Clerkships: Results of a National Survey. Acad Med 2025;100 (1), 78-85.
7.  AAMC Core Entrustable Professional Activities for Entering Residency: Curriculum Developers’ Guide 2014. https://store.aamc.org/downloadable/download/sample/sample_id/63/%20

Author: Catherine Derber, M.D.; Eastern Virginia Medical School. Organization: Clerkship Directors in Internal Medicine