What is the “ideal” grading system for the junior surgery clerkship?

BACKGROUND: There is currently no consistency in grading systems for clinical clerkships across medical schools. METHODS: Surgery clerkship directors were surveyed regarding their current grading categories, distribution of grades across levels, and opinions about the “ideal” grading system. RESULTS: Responses were received from 103 of 134 schools (77%). The following grading systems were employed: numerical scores, 1%; points, 1%; pass/fail, 5%; letter grades, 19%; and descriptor terms, 74%. Institutions used the following number of grading categories: 2, 5%; 3, 18%; 4, 35%; 5, 37%; 6, 3%; and 7, 1%. There was considerable variation between schools in frequency distributions across levels. Half of clerkship directors were satisfied with their system, and most considered an ideal system to consist of 4 or 5 descriptors. CONCLUSIONS: We believe an optimal clerkship grading system should consist of 4 or 5 categories. A 3-level system does not sufficiently discriminate, and with more than 5 categories the lowest levels are rarely used. Grades must be reported with clear information about their significance in each institution.