Medical student perceptions of assessment systems, subjectivity, and variability on introductory dermatology clerkships

BACKGROUND: Elective introductory clerkships in dermatology serve a critical function in providing formative experiences to medical students interested in the field. Although dermatology clerkships play a pivotal role in students’ career choices and residency preparation, the assessment systems used to evaluate students on these clerkships are widely different and likely affect student experiences. OBJECTIVE: This study aimed to explore the relationship between dermatology clerkship assessment systems and student experiences through interviews with students about their clerkship reflections and perceptions of assessment. METHODS: The authors contacted clerkship directors via the Association of Professors of Dermatology mailing list and invited them to provide a description of the assessment system at their institution. The authors, via contacted clerkship directors, then invited students who had completed an introductory dermatology clerkship in between 2018 and 2019 to provide a description of the assessment system at their institution and to participate in a qualitative interview about their experiences with assessment systems. The authors then iteratively synthesized interview transcripts using phenomenological analysis, in which a templated approach was used to achieve comprehensive thematic categorization. RESULTS: Prior to clerkship onset, students expressed a limited understanding of their clinical role and the assessment system. During the clerkship, students endorsed variable expectations across preceptors, limited feedback experiences, and pressures to perform for evaluators. After their clerkship, students continued to perceive assessment systems as nontransparent, subjective, and preordained. CONCLUSION: Medical students perceived assessment systems on introductory dermatology clerkships to be unclear and arbitrary. Encouragingly, students also viewed these challenges in assessment as malleable, identifying several opportunities for educational reform in dermatology clerkships.