LCME Element 9.8 – Fair and Timely Summative Assessment

A medical school has in place a system of fair and timely summative assessment of medical student achievement in each course and clerkship of the medical education program. Final grades are available within six weeks of the end of a course or clerkship.

Hidden Curriculum

This element is frequently cited and has evolved from focusing primarily on the timeliness of submissions to also considering student perception on the fairness of grades. While timely submissions were once the primary measure, how students perceive and experience these submissions now plays a crucial role in evaluating the element’s performance. In keeping with the timely part of this standard – whatever your school’s policy is – the committee will take that into consideration. So, for example, if you have a 4-week deadline but never ever meet it – and it’s really just there so you get grades in by 6 weeks – some survey teams are not going to look kindly on that. Further – If you have ONE clerkship/course that it is out of line- that can sink you into citation land.

Best Practice

Medical schools should implement a fair and timely system for summative assessment of student achievement in each course and clerkship. One way is making sure you have a Grades Submission Policy in place. Your school’s Grades Submission Policy should establish that grades are due within six weeks, with compliance centrally monitored. This policy must be mandatory for all faculty members, residents, fellows, and other educators involved in teaching, facilitating, or precepting medical students, whether on-campus, off-campus, or at branch campuses.

Your school’s version of Grades Submission Policy should require course directors to submit final grades to the Office of the Registrar within a set timeframe, (e.g., 4 weeks) after a course ends. Whoever is monitoring if grades are in (accreditation office, assessment office etc.) should have an escalation plan in place if grades aren’t in by 4 weeks. For example, if the due date has passed, follow-up emails should be sent, copying the relevant dean, vice chairs of education, chairs etc.

Clearly this element needs to be part of your CQI process.  It is a good idea for compliance metrics to be collected quarterly and annually for all courses and clerkships. These results need to be sharded with the Curriculum Committee, relevant subcommittees, course/clerkship directors, department chairs, UME deans, and the Medical School Dean. Action should be swiftly taken if problems. There is really no excuse for grades not to be on time. The LCME is not going to be lenient with you on this. Remember that while you MUST have your ducks in a row on this for required courses – you should also be monitoring elective grades as well. The grades submission policy should apply for ALL courses! Right now schools are not asked to report on this, but if you are not doing well – they can ask you anything…so be prepared!

The Grades Submission policy should be disseminated in a multi modal manner like all policies. Examples of this are having it on your website, in the student manual, in the faculty teaching manual, referred to in annual faculty renewal letters, having course directors review the policy at annual residency meetings and departmental meetings etc. Course and Clerkship directors should be reviewing this policy with their faculty, along with a myriad of others,  as part of  pre-course meetings and emails. Students value transparency, particularly when it comes to fairness in clinical assessments and grading. To address this, communicate your assessment and grading practices clearly during clerkship orientations, on your school’s course webpages, and in syllabi. Get granular and make sure it is indeed fair. Ask about fairness of grades on your annual internal surveys where you mimic the ISA questions.  As this one can take a looooong time to fix – if there are issues – get on it!  Meet with students via Town Halls and/or focus groups to find out what the issues are and begin working on solutions. Ensure that your Curriculum Committee’s recommendations promote transparency, fairness, and standardization in assessment practices, while supporting these efforts with ongoing faculty development.

Continuous Quality Improvement

Student concerns about Fair and Timely Summative Assessment often come through in year-end surveys. Regularly review these surveys to spot any dissatisfaction and inform leadership to address these issues.  And of course, review Timeliness of Grades regularly as well!