Analysis of emergency medicine clerkship grades by identification as underrepresented in medicine (URiM) versus non-URiM

Abstract

Background

Previous studies identified racial differences in core clinical clerkship evaluations and components of residency applications, including the medical school performance evaluation and standard letter of evaluation. However, there are no studies that have examined grading differences in the emergency medicine (EM) clerkship. Our goal was to determine whether there are differences in EM clerkship grades and its components (National Board of Medical Examiners [NBME] exam scores and clinical assessments) between underrepresented in medicine (URiM) and non-URiM students.

Methods

This retrospective sample was drawn from University of Michigan Medical School students with graduation year (GY) 2021 or 2022 who completed the required EM clerkship. We compared overall composite scores on the EM clerkship, EM NBME exam score, and clinical assessments between URiM and non-URiM students.

Results

A total of 334 students completed an EM rotation in GY 2021 and 2022. Eleven students with “missing” race data were excluded. Fifty-two (16.1%) identified as URiM while 271 (83.9%) identified as non-URiM. Non-URiM students significantly outperformed the URiM group (non-URiM mean 81.2, URiM mean 77.6; p = 0.0001). There was no statistically significant difference for clinical performance (6.71 vs 6.49 p = 0.057). Overall clerkship grades differed, as URiM students had higher percentages of “pass” grades (32.7%) and lower percentages of “honors” grades (40.4%) than non-URiM students (13.7%, 59.4%). When controlling for NBME shelf exam score, there were still differences in outcomes between URiM and non-URiM students.

Conclusions

There are grading differences between students who identified as URiM and non-URiM. There is a statistically significant difference with respect to outcomes on NBME shelf exam scores, which is responsible for a portion of these differences; however, when controlled for NBME scores, there was still a difference between these two groups. This calls for a change in how students are evaluated to address equity concerns in clinical assessments.