Education CLINICAL ASSESSMENT OF MEDICAL STUDENTS IN EMERGENCY MEDICINE CLERKSHIPS: A SURVEY OF CURRENT PRACTICE Luan Lawson, MD, MAED,* Julianna Jung, MD,† Douglas Franzen, MD, MED,‡ and Katherine Hiller, MD, MPH§ *Department of Emergency Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina, †Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, ‡Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, and §Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona Corresponding Address: Julianna Jung, MD, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287 , Abstract—Background: Assessment practices in emer- gency medicine (EM) clerkships have not been previously described. Clinical assessment frequently relies on global ratings of clinical performance, or ‘‘shift cards,’’ although these tools have not been standardized or studied. Objective: We sought to characterize assessment practices in EM clerk- ships, with particular attention to shift cards. Methods: A survey regarding assessment practices was administered to a national sample of EM clerkship directors (CDs). Descrip- tive statistics were compiled and regression analyses were performed. Results: One hundred seventy-two CDs were contacted, and 100 (58%) agreed to participate. The most heavily weighted assessment methods in final grades were shift cards (66%) and written examinations (21–26%), but there was considerable variability in grading algorithms. EM faculty (100%) and senior residents (69%) were most commonly responsible for assessment, and assessors were often preassigned (71%). Forty-four percent of CDs re- ported immediate completion of shift cards, 27% within 1 to 2 days, and 20% within a week. Only 40% reported return rates >75%. Thirty percent of CDs do not permit students to review individual evaluations, and 54% of the remainder de- identify evaluations before student review. Eighty-six percent had never performed psychometric analysis on their assessment tools. Sixty-five percent of CDs were satisfied with their shift cards, but 90% supported the development of a national tool. Conclusion: There is substantial vari- ability in assessment practices between EM clerkships, raising concern regarding the comparability of grades be- tween institutions. CDs rely on shift cards in grading despite the lack of evidence of validity and inconsistent process vari- ables. Standardization of assessment practices may improve the assessment of EM students. Ó 2016 Elsevier Inc. All rights reserved. , Keywords—assessment; clerkship; education; medical student INTRODUCTION The fundamental goal of assessment in medical education is to measure the extent to which learners are competent to function as clinicians. Among medical educators, there has been increasing interest in defining and measuring clin- ical competency, as evidenced by initiatives like the Accreditation Council for Graduate Medical Education’s Core Competencies, the Next Accreditation System/Mile- stones Project, and the American Association of Medical Colleges’ Entrustable Professional Activities (EPAs) (1–4). Within emergency medicine (EM), there are published national milestones at the undergraduate and graduate levels, although there is considerable variability in the extent to which these are taught, assessed, and achieved (5–9). This is in part caused by the lack of Reprints are not available from the authors. RECEIVED: 23 February 2016; FINAL SUBMISSION RECEIVED: 15 June 2016; ACCEPTED: 29 June 2016 1 The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–7, 2016 Ó 2016 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2016.06.045