Grading
What follows is a system of evaluation that has been used widely at other institutions. This
system organizes the skills, knowledge and attitudes included above into levels of accomplishment
necessary for various grade levels. The system is descriptive and therefore not only easy to remember but
useful for giving feedback to students. For example, if a faculty member decides that a student is
performing at the reporter level, the student and faculty member should work out clear goals that the
student might achieve to reach the interpreter level. The “Reporter” level is equivalent to a pass,
“Interpreter” to a High Pass and a “Manager” to an honors. The “Educator level” is achieved by only our
best third years and would also receive an honors. Of note, students must demonstrate mastery of the
skills of the previous level before being considered for the next level.
The following summary is adapted from the references below:
Reporter (Pass)
Students must accurately gather information about their patients from all sources including, but
not limited to, an independent history and physical examination and chart review. The student must use
appropriate terminology to clearly communicate his/her findings both orally and in writing; interact
professionally with patients and staff; and consistently and reliably carry out his/her responsibilities. This
level requires skills mastered in physical diagnosis brought to a level that enables the student to be a
useful team member. “Reporters” have an adequate knowledge base, the basic skills to perform
fundamental tasks, and core attributes of honesty, reliability and commitment.
Interpreter (High Pass)
Students must demonstrate their ability to identify and prioritize problems independently; offer
three reasonable explanations for new problems and generate and defend a differential diagnosis. This
step requires a greater knowledge base, increased confidence and skill in selecting and applying clinical
facts to a specific patient. Students should begin to demonstrate the ability to pose clinical questions.
“Interpreters” organize, prioritize, synthesize and interpret problems.
Manager (Honors)
Students must be more proactive, suggesting diagnostic and therapeutic plans that include
reasonable diagnostic options and possible therapies. This step requires greater knowledge, more
confidence and skill to select interventions for an individual patient. Students should routinely pose
clinical questions important to the management of their patients. “Managers” tailor plans to the particular
patient’s circumstances and preferences.
Lavin B, Pangaro L. Internship Ratings as a Validity Outcome Measure for an Evaluation Process to
Identify Inadequate Clerkship Performance. Acad Med. 1998; 73: 998-1002.
Pangaro L. A New Vocabulary and Other Innovations for Improving Descriptive Intraining Evaluations
Acad Med. 1999; 74: 1203-1207.