Disparities in Medical School Clerkship Grades Associated with Sex, Race, and Ethnicity: A Person-Centered Approach

Paulina Perez Mejias; Gustavo Lara; Alex Duran; Rashelle Musci; Nancy A Hueppchen; Roy C Ziegelstein; Pamela A Lipsett

doi:10.1097/ACM.0000000000005690

Disparities in Medical School Clerkship Grades Associated with Sex, Race, and Ethnicity: A Person-Centered Approach

Acad Med. 2024 Mar 14. doi: 10.1097/ACM.0000000000005690. Online ahead of print.

Authors

Paulina Perez Mejias¹, Gustavo Lara², Alex Duran³, Rashelle Musci⁴, Nancy A Hueppchen⁵, Roy C Ziegelstein⁶, Pamela A Lipsett⁷

Affiliations

¹ P. Perez Mejias is a senior assessment, evaluation, and education research specialist, Office of Assessment and Evaluation, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-8024-4843.
² G. Lara is a senior business intelligence analyst II, Office of Assessment and Evaluation, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-1787-2222.
³ A. Duran is director, Office of Assessment and Evaluation, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-5810-0237.
⁴ R. Musci is associate professor and doctoral program director, Department of Mental Health and Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-7267-5822.
⁵ N.A. Hueppchen is associate dean of undergraduate medical education and associate professor of maternal-fetal medicine, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁶ R.C. Ziegelstein is vice dean for education, Mary Wallace Stanton Professor of Education, and Sarah Miller Coulson and Frank L. Coulson, Jr., Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁷ P.A. Lipsett is assistant dean of assessment and evaluation, Warfield M. Firor Endowed Professorship in Surgery, program director, General Surgery, and surgical critical care co-director, Surgical Intensive Care Unit, Johns Hopkins School of Medicine, Baltimore, Maryland.

PMID: 38489478
DOI: 10.1097/ACM.0000000000005690

Abstract

Purpose: To determine whether students' self-reported race/ethnicity and sex were associated with grades earned in 7 core clerkships. A person-centered approach was used to group students based on observed clerkship grade patterns. Predictors of group membership and predictive bias by race/ethnicity and sex were investigated.

Method: Using data from 6 medical student cohorts at Johns Hopkins University School of Medicine (JHUSOM), latent class analysis was used to classify students based on clerkship grades. Multinomial logistic regression was employed to investigate if preclerkship measures and student demographic characteristics predicted clerkship performance-level groups. Marginal effects for United States Medical Licensing Exam (USMLE) Step 1 scores were obtained to assess the predictive validity of the test on group membership by race/ethnicity and sex. Predictive bias was examined by comparing multinomial logistic regression prediction errors across racial/ethnic groups.

Results: Three clerkship performance-level groups emerged from the data: low, middle, and high. Significant predictors of group membership were race/ethnicity, sex, and USMLE Step 1 scores. Black or African American students were more likely (odds ratio [OR] = 4.26) to be low performers than White students. Black or African American (OR = 0.08) and Asian students (OR = 0.41) were less likely to be high performers than White students. Female students (OR = 2.51) were more likely to be high performers than male students. Patterns of prediction errors observed across racial/ethnic groups showed predictive bias when using USMLE Step 1 scores to predict clerkship performance-level groups.

Conclusions: Disparities in clerkship grades associated with race/ethnicity were found among JHUSOM students, which persisted after controlling for USMLE Step 1 scores, sex, and other preclerkship performance measures. Differential predictive validity of USMLE Step 1 exam scores and systematic error predictions by race/ethnicity show predictive bias when using USMLE Step 1 scores to predict clerkship performance across racial/ethnic groups.