There was a recent article in Academic Medicine by Dr. Alexander and colleagues from Brigham and Women's Hospital describing the amount of variability in clerkship grading among US medical schools. They found that, unsurprisingly, the grading systems for the clinical years had really no consistency at all. There was inconsistency among the grading systems used (traditional ABCDF or honor/pass/fail or pass/fail) - (table 1), and even within the schools which used a similar scale the percentage of students receiving the highest grade was all over the place (table 2). So, the question is what do we do with this information? I think no one really expected findings that were different, but now the answer is out there, in print (or on digital reader screens).
I don't think these interests are necessarily incompatible, but they create a tension which I've seen in national meetings and in local curricular meetings. I also think most clerkship directors are not aware of how this tension affects the grading system they have developed. I think their not aware as the debates I've heard are usually about tools for assessment or the numbers of honors. Rarely does the debate get to the level of what is our ultimate purpose for the assessment. The answer to that question must shape how grades are assessed. Only when we all become very clear about what we our goals are for the assessment will we truly be able to come to a place where we can have a national dialogue about how to unify the system.