5.4: Evaluation of Performance in Clinical Clerkships

Criterion-Based Evaluation System (CBES)

CBES refers to the evaluation system used in required clerkships at Stanford. Student performance is assessed in three domains:  Patient Care, Professionalism and Interpersonal Communication, and Medical Knowledge, as measured by a final written exam. Performance in each domain is reported separately in the Medical Student Performance Evaluation (MSPE), without reference to an overall grade.

Note: Beginning in Clerkship Period 1, 2010-11, all students taking required clerkships will be evaluated using the Criterion Based Evaluation System (CBES) model. From Period 1, 2010-11 to Period 8, 2019-20, students were eligible for a Pass With Distinction (PWD) notation on the Medical School Performance Evaluation (MSPE). The PWD notation applied only to required clerkships; it did not apply to elective clerkships or pre-clerkship courses. PWD notations have not been offered since Period 9, 2019-20 and will not be offered during academic years 2022-23 and 2023-24.

Final Exam

  • Written exam requirements are set by the clerkship director.
  • Clerkships may use either the NBME Subject Exam or an alternative departmental exam. Clerkships using the NBME Subject Exam are marked with an asterisk above.
  • Written examinations must be passed with a minimum score as established by the clerkship.
  • Clerkship Exam thresholds for “pass” are determined by each core clerkship and will be noted in each clerkship’s respective syllabus and/or orientation.
  • Students who do not pass the written exam receive an “N” (continuing) grade for the clerkship and must retake either the NBME Subject Exam or the departmental exam.
  • Students who do not pass the written exam on the second attempt must take an oral exam or a suitable alternative, to be determined by the clerkship director in conjunction with the Assistant Dean for Clerkship Education.
  • After the third attempt at satisfying the exam requirement, the “N” grade converts to either “pass” or “fail.”
  • “N” grades must be corrected within 9 months of the end of the clerkship. Uncorrected “N” grades will convert to “fail” after 9 months.

Electives/Selective Clerkship Grading

Students on elective and selective clerkships may earn a final grade of Pass, Marginal Pass, or Fail. 

Mid-rotation Feedback

All required clerkships must provide students a formal mid-clerkship assessment of performance. Mid-clerkship feedback must be provided early enough to allow a student the opportunity to improve their performance before the end of the clerkship. Clerkships must maintain written documentation that mid-rotation feedback has been provided to each student.

Clerkship Performance Evaluation Appeals

Students who have questions or concerns about a performance evaluation in a clinical clerkship should contact the Clerkship Director to request a review. If a student’s disagreement remains unresolved, the student may request a review by the Clerkship Evaluation Committee (CEC) by completing the Request for Review form within eight weeks of the date that the final student performance evaluation was submitted in MedHub to be considered.

The CEC consists of the following members (or their designees) who will participate in each appeal or review:

  • Director of Evaluation (CEC chair)
  • Assistant Dean of Clerkship Education
  • A Required Clerkship Director other than the director involved in the appeal
  • Representative from the Educator-4-CARE program faculty
  • One additional faculty member (who does not hold a formal role in clerkships or CP3) from the Office of Diversity in Medical Education, Office of Medical Student Wellness, Office of Accessible Education, Office of Religious Studies, or Graduate Life Office, etc. at the request of the student or committee.

Upon receiving a request for review, the CEC will notify the clerkship team responsible for the performance evaluation and will gather data from the clerkship team. The CEC will review the final evaluation and all submitted data, gather additional information as needed, and will generally, though it is not required, reach a decision by consensus. The student and clerkship team will be notified in writing of the final decision. The CEC convenes as needed during even clerkship periods and decisions will be released within 7 days of the meeting.

The CEC decision is considered final. Students with further concerns may choose to independently pursue the Stanford University student academic grievance procedure, though they should recognize the limited scope of review inherent in that procedure.

Correction of Deficiencies in Clerkships

During the course of a clerkship, when a clerkship director becomes aware that a student’s performance may warrant a marginal pass or failing grade, the clerkship director must notify the student promptly that, in the absence of improvement, a non-passing grade is being considered. Once the director confirms the decision to assign a non-passing grade, the clerkship director must immediately notify the student about the final grade to be assigned. The clerkship director should also notify the student’s Advising Dean, who will arrange a meeting with the student.

Requirements for correcting a marginal pass or failure will be determined by the clerkship director. Students who receive a marginal pass or failing grade are required to meet with the clerkship director to set timely requirements for achieving an unqualified passing grade. Non-passing grades in clerkships (e.g., Failure, Marginal Pass, Continuing (N grades for failed NBME subject exams), Incomplete) must be corrected within 9 months of completing the clerkship. Students failing to correct a non-passing grade within 9 months will be reviewed and discussed by the Committee on Performance, Professionalism and Promotion.

Students cannot receive a Stanford MD degree with an uncorrected marginal pass or failure in a clerkship.

Clerkship deficiencies and corrections are recorded through MedHub evaluations, and are also tracked as internal “School of Medicine grades” in the Medical Education Platform (MEP) student record system, where students may view and track their academic progress.

updated January 2023