Assessment of Performance


There are several components to the clerkship grade, as outlined below.

There are two final exams given at the end of the clerkship. The National Board of Medical Examiners (NBME) Clinical Science Subject Examination in Surgery (“Shelf Exam”) consists of 100 multiple-choice questions and takes 2 1/2 hours. Students often report that US MLE-style practice question banks area helpful adjunct to reading for the purposes of Shelf Exam preparation. See the recommended resources listed above.

The Clinical Skills exam, developed at Columbia P&S, consists of five surgical cases representing a common problem or situation in general surgery. It is primarily a written exam (currently administered on computer using the Exam Soft platform), requiring that you apply to new or unfamiliar situations the knowledge and skills that you have learned and observed throughout your training. The best way to prepare for the exam is to learn as much as you can about the evaluation and management of your patients, and to review case-based study books such as the NMS Surgery Casebook. See the attached sample question included with this orientation guide for details. Specifically, you should:

  • know the indications, risks, benefits, and alternatives of common operations and think about how you would obtain appropriate informed consent for these procedures.
  • know the operative anatomy of common operations.
  • know how to approach an undifferentiated patient with a potentially surgical chief complaint, by appropriately tailoring the interview and physical exam to a rational differential diagnosis.
  • be able to formulate diagnostic and therapeutic plans for common surgical conditions, in accordance with evidence-based algorithms.
  • be able to interpret laboratory and radiographic study results for common surgical scenarios and apply these interpretations to the formulation of an appropriate management plan.

Please note that in addition to the shelf and clinical exams, students at all sites must submit one case write-up to their preceptor and complete at least one observed history and physical exam (see guidelines and evaluation form included in this packet).

The Clerkship Director determines the final grade.

Clinical Evaluations

Evaluator: Composite evaluations by preceptor and service house staff and attendings as identified by the student
% of Grade: 60%

Clinical Skills Exam

Evaluator: Clerkship Director
% of Grade: 30%

NBME Shelf Exam

Evaluator: Clerkship Director
% of Grade: ~10%

Definitions and approximate grade distribution (based on prior experience, not on quotas):

  • Honors (30-35%) – The student is excellent-outstanding in all competencies in all settings. Students scoring in the 8-9 range for all or most of the summary core competency evaluations, and who attain at least the mean score for their rotation group on both the NBME Shelf Exam and the Clinical Skills Exam, will be considered for Honors.
  • High Pass (50-60%)– The strong student who has a good fund of knowledge and excellent skills and who is progressing rapidly, or the student who is excellent-outstanding in some, but not all, competencies.
  • Pass (5-10%) – The student who exhibits strengths in some of the competencies, but who also has some areas that require attention and work.
  • Low Pass (<1%) – The student who is performing marginally in one or more competency, and who needs counseling but still has passed the course.
  • Incomplete (<1%) – The student who is performing unsatisfactorily in one or more competency, and who must demonstrate competence in a sub-internship before passing.
  • Fail(<1%) – The student who has note demonstrated adequate competence or progress; or who has exhibited significant unprofessional conduct.