HSC Education Days

PRIME Comparisons as Guidance for more Effective Surgical Clerkship Grading

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Objective: PRIME (Professionalism, Reporting, Interpreting, Managing, and Educating) is a common framework to evaluate student development and progression during third year of medical school. The purpose of this study is to compare trends in PRIME evaluation between internal medicine (IM) and surgery clerkships in a single institution.

Methods: Completed PRIME evaluations for Surgery and Medicine clerkships from September 2019 to March 2020 were collected. De-identified data including overall clerkship clinical performance grade, individual components of PRIME, and narrative comments for student feedback. This data was analyzed for mean and variance with comparison between the two clerkships.

Results: Of the total 638 PRIME evaluations reviewed, 407 were from Surgery and 231 were from Medicine clerkships (average 7.98 vs. 4.5 evaluations per student. The highest variance items for Surgery and Medicine were “Integrity and Work Ethic” and “Differential Diagnosis and Clinical Reasoning”, respectively. Though overall performance averages were similar between the two clerkships (Surgery 3.540, Medicine 3.477), there was high variability between averages within the sub-categories. Surgical evaluations contained lower averages in areas of professionalism whereas Medicine scores were lower in clinical evaluation subcategories.

Conclusion: In our analysis, high variance/low average may indicate a PRIME subcategory that evaluators from a certain specialty are appraising more closely. Areas of professionalism are overall more highly emphasized in surgical grading. Overall, Surgery PRIME evaluations were significantly more incomplete and required more aggregation, with categories such as “History” with greater than 10% of data incomplete. Grading on surgical clerkships may benefit from more highly nuanced professionalism grading tools and more specific expectation communication prior to the clerkship.

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